
Book- 
Gopyiiglit)^?. 



COPWIGHT DEPOSIT. 



SCHOOL llV(aENE 



SCHOOL HYGIENE 



BY 

LEO BURGERSTEIN, Ph.D., LL.D. 

'• (VIENNA) 



TRANSLATED BY 

BEATRICE L. STEVENSON, AND 
ANNA L. VON DER OSTEN 

WITH 43 ILLUSTRATIONS AND DIAGRAMS 




NEW YORK 

FREDERICK A. STOKES COMPANY 

PUBLISHERS 



\-> 






Copyright, 1916, hy 
Frederick A. Stokes Company 



All rights reserved 



U 




January, 1915 



JAN 22 1915 

S)CU391443 



INTRODUCTION TO THE AMERICAN 
EDITION 

The present century is discovering that the care of 
children is the most important thing in the world. 
Except in so far as children possess vitality, integrity 
and intelligence, nothing is worth while. In the past 
our cities have been built as if manufacturing and 
commerce were the great aims of the world. The 
discovery of childhood is the supreme achie-^ment 
of our day. The time is coming when cities will be 
built so that children may be well and happy, so that 
the treasures of past civilization, the precious inherit- 
ance of the achievements of the human spirit, shall be 
passed on to them most effectively. 

One of the leaders in this world-reconstructing view 
is Professor Leo Burgerstein, who has taken as his 
special theme the health of the school child, realizing 
that children in school are kept in school and under 
school influence, most of the hours of most of the 
days of most of the years of childhood. He says that 
the school must itself become a health-promoting 
agency, and the school curriculum a means which 
shall so influence the children that those who take 
part in it shall be better off in health and vigor than 
those who do not. The world is indebted to Professor 
Burgerstein for his scientific achievement, for his 

V 



vi INTRODUCTION 

breadth of scholarship, as well as for the practical 
nature of his teachings. 

This little book will bring to those American readers 
who are not already familiar with Professor Burger- 
stein's larger work in German, his general point of 
view with reference to this whole subject of the health 
of the school child. 

Luther H. Gulick, M. D. 

New York, October, 1913. 



PREFACE TO THE THIRD EDITION 

The preface to the first edition closes with the 
words: *Tt is difficult to set forth the results of an 
investigation in a way so as to be readily understood 
b}^ all, I shall be happy if I find that I have succeeded 
in this endeavor." The rapid sale of the second, 
extensive edition has shown that the chosen way was 
the right one. 

In addition to a change of text and enlargement of 
the index, the new edition of this little l)ook, which has 
won many friends and received much recognition, has 
been altered only to include our present knowledge of 
school hygiene. A few parts have been omitted, some 
chapters have been made more comprehensive, and 
new and more instructive illustrations have been 
added. The great increase in material with no cor- 
responding increase in the size or price of the book is 
due to the good management of m}^ publishers, and 1 
take this opportunity of expressing to them my thanks 
for their services. 

I desire also to thank my honored friend, Mr. Arthur 
Lieberman of Vienna, for his kind assistance in correct- 
ing proofs. 

Leo Burgerstein, Ph. D., LL. D. 
Vienna, April, 1912. 



vn 



MEASUREMENT EQUIVALENTS 



1 meter 

1 meter 

1 centimeter 

1 centimeter 

1 millimeter 

1 square meter 

1 square centimeter 

X degrees Centigrade 



3 . 3 feet 

100 centimeters 

.39 inch 

10 millimeters 

. 039 inch 

1 , 2 square yard 

. 15 square inch 
(Xxl.8)+ 32 = X degrees Fahrenheit 



Vlll 



CONTENTS 

(The figures in parenthesis refer to the number of the page.) 

Introduction to the American Edition v 

Preface vii 

Introduction xv 

I. THE SCHOOLHOUSE 
I. General Planning and Erection 

Planning (1)— Site (2)— Cottage Plan of Schools (4)— 
Location of Schooliiouse (7) — Water Supply (8) — Wells (8) 
— Drinking Fountains (9) — Construction (11)— School- 
house Entrance (12) — Waiting Rooms (12) — Cloak Koonis 
(12) — Lavatories (13) — Indoor Playgrounds (14) — Ar- 
rangement of Rooms (15) — Ground Plans (16) — The 
Classroom (18). 

2. Lighting 

Light Measurement (19) — Angle of Light (20) — Direction of 
Light (23)— Windows (24)— Curtains and Shades (25)— 
Light Reflectors (25)— Artificial Lighting (20)— Diffused 
Lighting (27)— Direct Lighting (28)— Gas Lighting (29) 

3. Ventilation and Heating 

Condition of the Air (29)— Dust (32)— Airing (33)— Venti- 
lation (34)— Heating (36)— Stoves (37)— Gas Heaters (38) 
— Steam Heating (40) — Hot-water Heating (40). 

4. The Classroom and its Equipment 

Size of Classroom (42)— Walls and Ceiling (44)— Floor (44) 
— The School Desk (46) — Adjustable School Furniture 

ix 



X CONTENTS 

(49) — Desk Dimensions (51) — Movable Desks (56) — 
Posture (58) — Blackboards (59) — ^Lavatory (59) — Ex- 
pectoration Receptacles (59). 

5. Other Rooms, Grounds, and Facilities of the School 

Gymnasium (60) — Playgrounds (61) — School Gardens (63) — 

, School Baths (63) — Swimming Pools (65) — Rooms for 

Domestic Science (66) — School Feeding (66) — Toilets 

(67)— Urinals (71)— School and Dwelling (72)— Cleaning 

(73)— Fire Regulations (74). 

II. THE HYGIENE OF INSTRUCTION 
I. General Considerations 

Fatigue (75)— Constitution (78)— Defective Children (79)— 
Special Classes (80) — School Age (81) — Co-education (82.) 

2. Number of Pupils and Curriculum 

Number of Pupils (88) — School Hours (91) — Carrying of Books 
(92) — Inspection for Personal Cleanliness (94) — Length of 
Instruction Periods (94)— Recesses (96) — Order of Subjects 
(101)— The One or Two-session Day (102). 

3. The Hygiene of Different School Subjects 

Reading (106) — Writing (109) — Vertical or Oblique Writing 
(111)— Handwork (116)— Domestic Science (116)— 
Manual Training (116) — Gymnastics and Play (118) — 
Singing (122). 

4. Homework, Examinations, etc. 

Homework (123)— Extra Work (127)— Examinations (127 
— Graduation Examinations (Reifepriifungen) (128) — 
Overwork (130) — Punishments (131)^Corporal Punish- 
ment (133) — School Suicides (135) — Other Punishments 
(136)— Vacations (136)— Summer Vacation (137)— Mid- 



CONTENTS xi 

term Vacations (138) — Suspension of School on Warm 
Days (139) — Vacation Colonies or Camps (140) — Excur- 
sions in Vacation (141) — Recreation Day Camps and 
Open-air Schools (141). 

5. Boarding Schools 
Open Air Boarding Schools (143). 

III. INSTRUCTION IN HYGIENE 

Hygiene in Training Schools (146) — Hygiene in I^lementary 
Schools (148)— Hygiene in High Schools (149)— Alcohol 
(150)— Tobacco (151)— Sex Hygiene (152). 

IV. SCPIOOL DISEASES AND MEDICAL INSPEC- 
TION OF SCHOOLS % 

Contagious Diseases (154) — Myopia (Nearsightedness) (150) 
— Spinal Curvature (157) — Subnormal Children (158) — 
The School Physician (159)— School Nurses (165)— 
School Clinics (166) — Historical Survey of Medical In- 
spection (167). 

V. HYGIENE OF THE TI^ACHING PROFESSION 

Difficult Schoolroom Conditions and Nervous Strain (173) — 
Overtime (174) — Consulting the School Physician (175). 

Bibliography 176 

Index 178 



ILLUSTRATIONS AND DIAGRAMS 

FIG . PAGE 

1. Pavilion school at Drontheim, Norway. Perspec- 

tive 5 

2. Pavilion school at Drontheim, Norway. Ground 

plan 6 

3. Ground and cross section of a school unit at Dron- 

theim, Norway 6 

4. A drinking fountain reciuiring no cup 10 

5. Ground plan of a one-room Danish schoolhouse. . 13 

6. Plan of the first floor in a London public schiol 

accommodating twenty classes 14 

7. Ground plan of a public school (thirty-two classes) 

in Frankfort, Germany 15 

8. A school and its grounds at ^'iroflay, France ... 17 

9. Photometer by Wingen 19 

10. Pleier's camera for measuring the angle of hght. . 20 

11. Photograph taken with the Pleier camera for meas- 

uring the angle of light 21 

12. Measuring the light on the desk farthest from the 

window 22 

13. Diffused lighting by Welsbach lamp 27 

14. The Meidinger stove 35 

15. Ventilation by temperature differences 36 

16. The Meidinger stove, interior view, showing ven- 

tilating system 37 

17. Steam heating 39 

18. Plan of a schoolroom with benches each accom- 

modating two pupils 43 

xiii 



INTRODUCTION 

It is a well-known fact that the beginnings of 
many modern activities can be traced back thousands 
of years. Such is the case with school hygiene, for 
evidence of its existence has been found as far back 
as the days of Greece. Even the modern form of 
school procedure is much like that of a far-removed 
age; the schoolhouse of the present with its equip- 
ment agrees in some respects with the schoolhouse 
and equipment described by Furttenbach.* ^here 
have been times in Germany when public opinion 
was disposed to consider with indifference a sound 
physical development in relation to school work. 
Even to-day, while the teaching profession generally 
appreciates the importance of school hygiene from a 
theoretical standpoint, in actual practice we are still 
feeling the effects of the earUer prejudiced times, and 
much progress needs to be made. Nevertheless, the 
right of the child is one of the demands of the times, 
and this demand includes the protection of the child's 
health in pubHc institutions. 

As the father of modern school hygiene we acknowl- 
edge the eminent physician, Johann Peter Frank, 
who, in the second volume of his great work, " System 
einer vollstandigen medizinischen Policey,"t sum- 

*F\trttenbach. "Toutsches Schul-Gebaw," Augsburg, 1649. 
fFRANK, Johann Peter. "System einer vollstandigen medizi- 
nischen Policey," Mannheim, 1780. 

xvii 



xviii INTRODUCTION 

marized the meaning of school hygiene. The science 
has, however, been broadened and made effective 
only during the past fifty years, when medical special- 
ists, in the interests of scientific knowledge, have 
examined large numbers of school children to deter- 
mine what disturbances of health are traceable to 
school life. In the train of these examinations many 
thorough investigations were taken up to determine 
the physical condition of school children and the state 
of sanitary equipment of the schoolhouse; and much 
knowledge has been gained and many hygienic im- 
provements have been introduced. In comparison 
with research in these directions, the hygiene of in- 
struction made its appearance relatively late, and is 
therefore far from being cleared up sufficiently. The 
demand for it must come from the schools, its 
teachers, and the specially trained school physicians. 
The hygiene of the teaching profession, developed 
in the spirit of modern scientific research, is like- 
wise only in its infancy. 

Practical hygiene so far as it concerns all matters of 
the school will succeed only when schoolmen generally, 
teachers, and the pupils themselves, understand the 
rules of health. As for the actual instruction in 
hygiene in the school, the subject is so comprehensive 
that it is impossible that all teachers shall be experts 
in this particular field; hence a demand has gradually 
arisen for a person especially trained in this branch 
of school work, namely, the school physician. 

It is important that the teaching profession take an 
active interest in school hygiene; there is no better 



INTRODUCTION xix 

way toward realizing the ideals of the science or of 
verifying the results of research. 

The fundamental points to be emphas'zed in this 
book have thus been indicated. Their discussion, 
which will be concise, will include matters of theory 
and practice in various countries. It will materially 
aid the advance of the science if teachers everywhere 
will accept the suggestions concerning the theory and 
practice in other lands in the spirit in which these 
suggestions are made, and as an incentive to progress 
in their own schools. 



SCHOOL HYGIENE 

I 

THE SCHOOLHOUSE 

1. General Planning and Erection 

The problem of schoolhouse planning differs from 
the ordinar}^ house planning in this respect that al- 
most every condition is altered. In a dwelling house 
the place where one sits to read is near the wi|^dow; 
in a schoolroom even the corners far removed from 
the windows must be used for this purpose. The very 
moment the threshold of the schoolhouse is crossed, the 
difference is apparent; many feet passing over a thres- 
hold bring in an unusual amount of dust. The school 
stairways, too, must at times bear the weight of crowds, 
and rooms which must accommodate many individuals 
make proper ventilation a serious matter. In fact, the 
characteristics of the schoolhouse serve to emphasize 
the difference ])etween it and the dwelling. 

Planning. — In order to avoid mistakes which cannot 
be remedied later, when the schoolhouse is being 
planned close attention must be given to the hygienic 
aspects. This requires careful study at the outset, a 
fact which has unfortunately been learned by experi- 
ence in those communities where it has been found 
that an attractive appearance does not always mean 

1 



2 SCHOOL HYGIENE 

good planning or suitable situation. Schoolhouse 
planning demands experts. In rural communities 
good model plans might be edited by the municipal 
authorities. In this way, even a small community 
could erect a satisfactory schoolhouse and be stimu- 
lated to undertake the work because those immediately 
interested, as, for instance, business men, could super- 
intend the matters of planning and erection. It is, of 
course, of material help toward the securing of good 
schoolhouses if the state is able to assist by subscribing 
loans without interest. Small and average-sized cities 
may succeed in securing good plans by initiating a 
building contest. The sketches submitted in the con- 
test should be passed upon by an expert in school 
hygiene. The primary aim in all cases must be to 
secure ideally hygienic conditions as far as the finances 
will permit. This necessity must precede all claims 
to beauty; panem et circenses, not the reverse, should 
be the rule. In the larger cities the aim should be a 
comprehensive study of schoolhouse construction in 
other countries as well. This study should include a 
review of the existing literature on the subject, and 
also the personal observations of an architect especially 
interested in this branch of his profession. 

Site. — It must be emphasized again that not 
every building will do for a schoolhouse and that the 
schoolhouse demands special construction. The choice 
of a site is important. The essentials are: quiet, 
air as good as the locality permits, and light 
which is not interfered with by adjoining buildings. 
A further essential is that these conditions be assured 
for the future. It happens frequently, especially in 



THE SCHOOLHOUSE 3 

small towns, that an otherwise desirable schoolhouse 
is placed entirely without necessity on a thoroughfare, 
merely because the town is proud to show it. The 
noise and dust of the thoroughfare prove disturbing 
factors. If the building must be put on a principal 
street, by all means let the corridors be on that side 
while the classrooms face the rear; ])ut a more favor- 
able location should be found, if possible. Further- 
more, in small places the plans should be such as to 
admit of the addition of annexes or stories. 

In rural districts, in order to have a generally ac- 
cessible schoolhouse, one must take into account the 
lay of the land, the distribution of the population, 
and the state of the roads. Instead of a separate 
school for each small village, it might be desilable to 
have one large school for a number of villages. The 
pupils might be brought to the school by conveyances, 
as is the system in vogue in certain parts of the United 
States, where several of the states have already pa:?sed 
legislative enactment on this point. It would be most 
helpful, both from the standpoint of hygiene and from 
that of school attendance, if in rural districts it were 
possible during the inclement season when the snow 
lies deep and transit is difficult, to organize a system 
whereby particularly the smaller children may be 
carried in conveyances alternatively by the farmers to 
and from school. In the northern part of Scandi- 
navia, where the farms are widely scattered, it has 
been found feasible to form so-called Wander schulen. 
In these, a number of children are fully taken care of 
for a number of weeks, until the teacher must move on 
to the next post. 



4 SCHOOL HYGIENE 

When quiet and good air are aimed at it is well to 
remember that these conditions are not likely to be 
secured where school buildings are situated in the 
vicinity of railway stations, near laundries where 
chemicals are used, or near factories. It would be a 
distinct advance if this matter could be controlled by 
law, for instance, the prohibition of such establish- 
ments within a mile of the schoolhouse. 

Cottage Plan of Schools. — In large cities, a realiza- 
tion of these ideals — quiet, good air and good light — 
is not easy, but the evils might be minimized if the 
municipal authorities would look ahead a few decades 
in the growth of their city and restrict certain sites in 
the suburbs for the use of schoolhouses and play- 
grounds. In the meantime, such tracts of land might 
be leased out for agricultural purposes. Some large 
cities have built their schools on the plan of one 
schoolhouse to so many thousand children, but this 
procedure does not always express a wise, far-sighted 
policy, for while the proportion of school children to 
the total population (in most countries from 13 to 20 
percent) is known, in some sections, for instance 
where a factory is being set up, the school population 
will increase out of all proportion to the provisions 
that have been made. To meet such needs, large 
school barracks must then be constructed in haste. 
Such cheap, lightly built structures, while they some- 
times admirably relieve a temporary need and have 
been known to give good service for years, are not 
to be recommended for general use, and should 
merely serve as an emergency measure in large cities. 
It may be that from some of the advantages of the 



THE SCHOOLHOUSE 



5 



school barracks has originated the cottage plan of 
school building, i.e., instead of one large schoolhouse, 
a number of smaller, separate units. The advantages 
here are better air and less mutual disturbance; it is 
easier to clear the rooms in case of fire, and the closing 
at times of epidemics need only concern one unit. On 
the other liand, drawbacks are again met with in the 
tax put upon the central heating system, and if shower 
baths are used the danger in cold weather of having 




Fig. 1. — Pavilion school at Dronthoim, Norway. Perspective. 

the children pass after the bath from one building to 
another. The comparatively large amount of space 
required for the pavilion school renders it not generally 
practicable and for this reason but few such schools 
have been erected, though they are to be found here 
and there, especially since Beutner in Ludwigshafen 
(Germany) has supplied a model. Figs. 1 and 2 show 
examples of the Hakonson-Hansen pavilion at Dront- 



6 



SCHOOL HYGIENE 



heim in Norway. The schoolhouse is of wood, 
centrally heated by steam and ventilated mechanically. 
The house in the rear of Fig. 2 is the gymnasium 



STREET 




SCHOOL 
UNIT 



Thouse I'^^^ 



PLAYGROUND 
FOR GIRLS 



SCHOOL 
UNIT 



5 ID 50 TOm 

|imHH 1 1 1 1 , j 

Fig. 2. — Pavilion school at Drontheim, Norway. Ground plan. 




5 

1 ' ' ' ■ I 



10 



30 m 



Fig. 3. — Ground plan and cross section of a school unit at 

Drontheim, Norway. 

where classes in physical exercise and training for 
sloyd work are conducted. Fig. 3 shows the ground 



THE SCHOOLHOUSE 7 

plan and a cross section of one of the pavilions, with 
six classrooms, each accommodating 36 pupils. 

Points relating to the size of school plots will be 
taken up later; it is sufficient to say here that the 
grounds can never be too large when play spaces are 
taken into consideration. School buildings should 
never be placed on sites formerly used as refuse dumps, 
on ground where underground currents of water come 
near the surface, or in marshy places. 

Location of Schoolhouse. — A much discussed ques- 
tion is the location of the school building with respect 
to the point of the compass. The great influence 
that the sun has as a hygienic agency is well expressed 
by the forceful old Italian saying that, ''Where the 
sun never goes, the doctor must go." Sun^ine is 
especially important for the physical and moral health 
as well as the happiness of children. On the other 
hand, the sunlight which falls directly on the page 
when the child is reading or writing is harmful to the 
eyes. Curtains or screens are then necessary. It 
must also be remembered that a very sunn}' room well 
filled with children is decidedly uncomfortable in 
summer. Local conditions, such as a mild or a 
severe climate, strong or badly nurtured children, 
distribution of class hours, etc., play important 
parts. For the health of the children, sunny situations 
are on the whole preferable to the northern exposure . 
which has recently been advocated. The value of 
sunshine is not to be overlooked when ideal situations 
can be obtained. In the large city, where a school- 
house must be placed of necessity in a-street with other 
houses, the choice of location of the rooms is naturally 



8 SCHOOL HYGIENE 

strictly limited to their distribution within the 
schoolhouse. 

Water Supply. — The quality of the water supplied 
to a school is a matter of the utmost importance, as 
impure water may be the source of dangerous disease. 
Filters are not to be recommended because they soon 
become choked with bacterial organisms and are 
sterilized with difficulty. At the first appearance of 
an epidemic which points suspicion to the water 
supply, care should be taken to sterilize all water 
used for drinking purposes. It should be boiled for at 
least half an hour in bottles placed in a kettle filled 
with water. A little cold tea or lemon juice added 
to the boiled water takes away the flat taste. 

A central water supply is gradually being recognized 
as a necessity in all large communities, for a badly 
situated or a badly managed well is too apt to become 
a source of epidemics. 

Wells. — In country places, which lack a central 
supply and where it is not always possible to have 
scientific supervision to insure purity of the water, 
especial care should be given to the location of the 
well; the site must be absolutely without question. 
Unfortunately rural wells are often a mockery of the 
laws of hygiene. Hence the school well should be a, 
model to the community. To inculcate this lesson in 
the children, on occasions it might be desirable to 
show a plan and cross section of a good well to the 
older pupils, and to explain to them the dangers of a 
bad location. Concerning a good situation for a well, 
the points are briefly these. If the ground has good 
filtration powers, a vertical depth of about 5 meters 



THE SCHOOLHOUSE 9 

insures water free from bacteria; the filtration of 
water running obliquely to the well must also be 
considered. At all events, deep wells of at least 8 
meters are superior to surface wells. It goes without 
saying that there should be no toilets, lavatories, or 
manure heaps nearby, or even within a radius of 10 
meters. Wells should be dug to the depth of at least 
5 meters, and the shaft should be water-tight. It is 
desirable to project the coping of the well about 30 
centimeters alcove the ground; the cover also should 
be water-tight. It is better not to have the well-pipe- 
drop in the middle of the shaft. The spout of the 
pump should project beyond the well covering, and 
the trough to carry off the water should be water-tight 
and lead at least 5 meters away, so that there %hall be 
no soaking in of dirty water. Drilled or driven wells 
are to be advocated where the ground is adaptable. 

The school well has been discussed at length because 
investigation has proven that in rural districts it is 
frequently' found to be a menace to public health, 
and the opportunity of calling attention to this evil 
may often ])e presented to those informed on this 
important matter of hygiene. 

Drinking Fountains. — The drinking fountain is 
next in importance to the water supply. In most 
schools the only provision made is the common drink- 
ing cup, in some a few tum})lers are provided for a 
whole class of children. It will generally be found 
that school children rarely rinse the common cup ; or if 
they do, the operation lacks thoroughness. The saliva 
adhering to the rim can only be efficiently removed 
by a strong flow of water, and there is little inclination 



10 



SCHOOL HYGIENE 



on the part of children to do this thoroughly and 
sometimes also there is a lack of time. The serious 
consequences can readily be foreseen; a child infected 
with diphtheria may spread the disease among those 
who drink after it out of the same cup. Individual 
drinking cups, one for each child, should be used in 
place of the common cup. For those who are too 
poor to buy a cup, some charitable provision might be 

made. This individual 
cup should be kept in the 
school bag or in a special 
place provided for it in the 
desk similar to that pro- 
vided for the inkstand, or 
else the cups should be left 
in a designated spot and 
numbered for identifica- 
tion, the younger pupils 
having stars, or a cross, or 
half moon to identify 
theirs. It devolves upon 
parents and teachers to 
instruct the children not 
to lend their cups to others. 
Where running water of sufficient pressure is avail- 
able, a drinking fountain may be set up, one that 
requires no cup, but from which the water gushes 
directly into the mouth when a valve is pressed, as 
shown in Fig. 4. When the child has finished drink- 
ing, he releases the valve and the jet ceases, but the 
water continues to flow below the valve, washing 
away the drops which have fallen back from the 




I 



Fig. 4, — A drinking fountain 
requiring no cup. 



THE SCHOOLHOUSE 11 

mouth. In this way the lips of the drinking person 
do not touch the opening of the fountain which is 
below him in the depth of the basin. Fountains such 
as these were introduced into a Vienna school in 1906 
on the occasion of an anniversary.* It is greatly to 
be desired that other cities will follow the example of 
this school by the introduction of equally hygienic 
improvements on similar occasions. In the United 
States fountains are used extensively as a result of 
the legislation wliich has been passed prohibiting the 
use of public drinking cups. While New Jersey, 
Florida and Indiana led the other states in this 
action against the common cup, there are at present 
more than a dozen states and fully as many cities 
which have done away with the use of public (Mips in 
schools. 

Construction. — There is no special need for dwelling 
upon the hygienic side of building materials or con- 
struction further than to say it is generally conceded 
that a cellar is desirable, though not absolutely neces- 
sary when there is a good foundation of concrete and 
floors which will keep out the cokl. It is well to pre- 
vent the rise of ground water in the walls by using 
layers of insulating nt^aterial in the foundation under 
the floors. Onl}^ dry and moisture proof material 
should go into the making of partitions. To get the 
necessary warmth and required freedom from noi^e 
it is best not only to deaden the beam coverings and 
flooring, l^ut also partly to fill up the intervening 
spaces. Certain newly devised building materials, 

*The model was a good, cheap one invented by Oreffice of 
Padova (Italy). 



12 SCHOOL HYGIENE 

made of iron and concrete, are admirable for filling 
in. House fungus, the presence of which may be- 
come unhygienic and a source of expense when it 
requires removal (though not considered a poisonous 
growth) may be avoided by the use of thoroughly dried 
wood. Staircases which are absolutely fireproof both 
as to the treadway and its covering are essential. 
The new schoolhouse should not be thrown open for 
use until it is thoroughly dried out. 

Schoolhouse Entrance. — No schoolhouse, not even 
the smallest, should discharge its pupils directly into 
the street. In large schools, at least one entry for 
every three hundred pupils is desirable. In the entry 
room of every schoolhouse, large enough provision 
should be made to have the pupils wipe their shoes 
thoroughly before coming into the classrooms. Since 
the prevention of dirt in the house is easier attended 
to than the operation of cleaning, the pupils should 
become accustomed to make systematic use of the dust 
mats, etc., from the beginning of their schooling. 

Waiting Rooms. — Waiting rooms situated near the 
entrance are most desirable in city schoolhouses, for 
the convenience of those who escort the children to 
and from school. 

Cloak Rooms. — Of especial concern to the health of 
the school population are the rooms where wraps and 
umbrellas are deposited. If these articles are kept 
in the schoolroom itself, the warmth of the room and 
the dampness of the clothing together will soon cause 
deterioration of the local atmosphere. It is by all 
means desirable to have a special cloak room. Such 
accessory rooms have gradually become an acknowl- 



THE SCHOOLHOUSE 



13 



edged necessity in many countries. (See Fig. 5.) It 
is also recommended that in the cloak room provision 
be made for drying the damp footwear of the children 
and that each child might have a pair of dry shoes and 
stockings for change. Cloak rooms should, of course, 
be well heated in winter and well ventilated at all 
seasons; children who come early to school might be 
appointed to attend to these conditions. Hallways 
may also be used as wardrobes. 




•*\\\\ CLOAK 



Fig. 5. — Ground plan of a one-room Danish schoolhouse. 



Lavatories. — The cloak rooms found in the London 
schools deserve special commendation, because of the 
hygienic provisions they make for the cleanliness of 
the pupils. As the children come in, a teacher inspects 
them, and those who are in need of soap, water and a 
towel, are accorded these privileges. There are four 
washstands for every one hundred children of the 
school. (See Fig. 6.) In respect to that much in- 



14 



SCHOOL HYGIENE 



volved question, the hygiene of the towel, we should 
like to suggest that in schools not frequented by the 
very poor, each child should bring his own towel with 
him to school and carry it home to be dried. The 
very poor children could have towels given to them. 
Indoor Playgrounds. — School children should have 
a well-warmed room in which to spend the recess in 
inclement weather. (See Fig. 8.) As it is generally 
admitted that the needed amount of play space for 
each child, even in large cities, is at least one-half 




J Boy's Stairs 



Boy's Stairs 



.10 



40m 



Fig. 6. — Plan of the first floor in a London public school accom- 
modating twenty classes. 



square meter of space, the amount necessary for this 
purpose can easily be computed. The free space thus 
available for the recreation of the children may be 
augmented by the wardrobe space, i.e., where the 
clothing is hung in the corridor in a wire cage open to 
the air. On the whole, it would seem to be wise to 
make the corridors only just as wide as is absolutely 



THE SCHOOLHOUSE 



15 



necessary, and the stairways not more than a meter in 
width (but increasing the number of such stair- 
ways), in order that the common recreation hall for all 
the classes on a floor may be as large as possible. Fig. 
6 shows a hall of this character. It admits of easy 
supervision and may be used as an assembly room 
by a number of classes. 



APPARATUS 
ROOM 




lom 



Fig. 7. — Ground plan of a public school (32 classes) in Frank- 
fort, Germany. 

Arrangement of Rooms. — In the arrangement of 
the rooms within the schoolhouse, the classrooms must 
necessarily receive first consideration with respect to 
good light and a quiet location; passageways, stairs, 
offices, showrooms for collections of educational 
appliances, reception rooms and assemblies take 
second place. The indoor recreation rooms, as well 



16 SCHOOL HYGIENE 

as the playgrounds, should be located so as to be easily 
supervised. Most unfortunate is the location of a 
schoolhouse in a crowded quarter, where almost all 
space is used for stairs and classrooms; greatly to 
be recommended on the other hand is the type of 
schoolhouse with classrooms on only one side of the 
corridor as shown in Fig. 7. 

In the following paragraphs a few selected ground 
plans for different types of schools are described. 

Ground Plans. — One of the most significant means 
for the dissemination of education is the one-roomed 
schoolhouse of rural districts. The plan of a school- 
house of this type officially recommended in Denmark 
is shown in Fig. 5. Observe the small 'number of 
children accommodated, and also that the boys and 
girls have separate cloak rooms. The house is in- 
tended as a home for the teacher and his family 
and contains a guest chamber in the attic, besides 
other living rooms and premises not shown in the 
sketch. 

Fig. 6 shows the ground floor plan (girls' floor) of a 
three-storied London public school accommodating 
twenty classes. The cloak room with lavatory and 
hall, where children can gather in bad weather before 
morning instruction begins, will be seen. The boys' 
floor, the stairs leading to which are shown, is above, 
while the kindergarten is below. Fig. 7 shows the 
left half of a ground plan of the girls' division of a 
four-storied public school, accommodating altogether 
thirty-two classes, found in Frankfort-on-the-Main 
(Germany). It will be observed that the window 
posts are narrow and that the classrooms are situated 



THE SCHOOLHOUSE 



17 




10 



50ni 



Fig. 8. — A school and its grounds at Viroflay, France. 
2 



18 SCHOOL HYGIENE 

only on one side of the corridor, the gymnasium being 
only one story high. 

In France and England, and recently in Germany 
and Italy, the kindergarten has been combined with 
the elementary school. Fig. 8 shows a ground plan 
of a French group of schools (groupe scolaire). The 
elementary school is designed for three boys' and 
three girls' classes, and the kindergarten is in the 
rear. The upper parts of the buildings not shown 
in the sketch contain janitor's quarters, which are 
accessible by a separate stairway. Of special interest 
are the covered outdoor recreation spaces and the 
playgrounds. 

The Classroom. — From a discussion of schoolhouse 
plans in general, we turn to a consideration of the 
individual rooms used for educational purposes, 
including the gymnasium. Of these, the ordinary 
classroom is the most important. It is the one room 
in the school building where the pupil spends most of 
his time and performs most of his tasks, including 
reading and writing, accomplishments which under 
unfavorable conditions may injure his health. A com- 
plete understanding of the hygienic requirements of 
this room will be gained only after a detailed considera- 
tion of lighting, airing, and heating. 

2. Lighting 

Hermann Cohn of Breslau, who for years worked in 
the interests of school hygiene, once said that a school- 
room can never have too much (diffused) light. The 
light of the sun is not only an aid to cleanliness and a 
foe to pathogenic micro-organisms, but the degree of 



THE SCHOOLHOUSE 



19 



sunlight also has important bearings on the general 
health of the body, as regards its functions of respira- 
tion, digestion, etc., as well as in the preservation 
of unimpaired eyesight and good posture. At a 
distance of 2 meters from a window, the light is 
only about 80 percent as bright as at 1 meter, at 
3 meters only 50 percent as bright. A realization 
of such values brings out the necessity for special 
study of how to light 
the schoolroom so as 
not to injure the 
sight of any of the 
occupants. 

Light Measure- 
ment. — The amount 
of light in different 
parts of the room can 
l)e ascertained and ex- 
pressed in figures by 
means of the photo- 
meter. It can be 
calculated in meter- 
candles, 1 meter- 
candle equalling the intensity of light which the flame 
of a standard candle throws on white paper at a dis- 
tance of 1 meter. The usual requirements are 25 
meter-candles measured in white light. 

An excellent, though costly photometer, is that of 
Weber; one designed by Wingen is smaller and simpler 
but not so exact. The latter (Fig. 9) consists of a 
little box about a span high in which is a benzine flame 
B, observed through S. The height of this flame is 




Fig. 9. — Photometer by Wingen. 



20 



SCHOOL HYGIENE 



regulated by means of the knob K, so that the amount 
of light cast upon the prism within the box at C 
(observed at M) can be made to correspond with 
the daylight cast on the pupil's desk at C" . Since 
the actinic values in the benzine light and daylight 
are not the same, it is necessary to compare the red 
part of each (R, the red glass) , and afterward to mul- 
tiply by a factor, in order to obtain the equivalent 
candle power of the daylight. 

Angle of Light. — There are also instruments for 
computing the angle of light falling on a pupiFs desk. 
By dividing the equator S of a globe into 360 degrees 

and constructing a 
square over each 
degree, or a '^ square 
degree," we have 
over 41,000 such 
square degrees for 
the whole of the 
globe. If one plots 
the number of 
square degrees of 
sky sending light on 
a horizontal sur- 
face, the so-called 
room angle is ob- 
tained, of which 50 degrees are demanded for each 
pupil's place. No computations are necessary with a 
little apparatus made by F. Pleier in Karlsbad.* It 
consists of a pocket camera (Fig. 10) in which a 
glass screen is placed between the plate and the lens. 

*lDstitut, F. Schmidt & Haensch, Berlin. 




Fig. 



10. — Pleier's camera for measur- 
ing the angle of light. 



THE SCHOOLHOUSE 



21 



This screen is made up of parallelograms each corre- 
sponding to 4 square degrees; but these parallelo- 
grams are of different sizes having been graduated 
according to the relative values of the light, corre- 
sponding to a greater or less angle of incidence. If the 
camera is placed on the child's desk and directed 
toward the light, a photograph can ])e taken like 
that of Fig. 11. It is possible in this way to estimate 
the light coming from four windows. In this picture 
the number of square de- 
grees of direct daylight, as 
well as reflected light is given, 
and all without further reck- 
oning, as the correct room 
angle is obtained because 
the differing light values in 
connection with the angle of 
incidence are already taken 
account of by the screen 
within the camera. By means 
of the photometer, especially 
by means of the apparatus to 
measure the room angle, it is 
possible to determine whether 
a room has sufficient light. 
Unfortunately, if this is 
found not to be the case im- 
provement seldom follows. 
As a matter of fact, the many badly lighted classrooms 
still in existence date from the time when hygienic 
matters were not considered; in such rooms children 
have suffered for decades. But as far as the building 




Fig. 11. — Photograph 
taken with tlie PI c i o r 
canuM-a for ineasuring the 
angle of light. 



22 



SCHOOL HYGIENE 



of new schoolhouses is concerned, our whole aim must 
be to see that badly lighted rooms shall no longer be 
erected, and this ideal does not involve the question 
of cost as an insurmountable difficulty. Still a school 
plan based on the most finished scientific methods may 
not be attainable even in large cities, not to mention the 
smaller towns, and on the other hand it is a fact that 
up to the present for various reasons the exact and 
scientifically incontestable minimum amount of light 




Fig. 12, — Measuring the light on the desk farthest from the 

window. 



necessary from the hygienic point of view has not 
been stated. But the following is a simple rule which 
any rural carpenter might follow when constructing a 
new school building. Thp rule merely demands 
direct daylight even on the desk farthest from the 
windows. Fig. 12 shows a carpenter's cross-section 
cut of a schoolhouse and one wall of a nearby building. 
The house shows the outside walls, one room with a 
window and a desk in the farthest corner. A line, 



THE SCHOOLHOUSE 23 

o — a, is drawn from the pupil's desk to the top of the 
window and extended outward; another line, a — u, 
is drawn from the top of the nearby building or 
whatever obstacle cuts off the light, and is brought 
to the pupil's desk. The angle between these hues 
shows the path of direct light to the desk. 

This aim of direct daylight on the desk of the pupil 
in the farthest corner of the room should be possible 
even in the largest cities. If it can not be achieved 
for the lower stories, these should not be used for 
school purposes, but rented out, or other disposition 
made of them. It need hardly be mentioned that in 
planning a schoolhouse, the building laws of the com- 
munity shoukl be carefully considered, so that it may 
not happen that well-lighted rooms will subsequently 
be deprived of their light through the erection of 
towering structures in the neighl)orhood. 

Direction of Light. — When schoolrooms are lighted 
by windows on only one side, as is usually the case, 
the windows should by all means be situated to the 
left of the pupils, for light coming from the left is 
most desiral)le for writing. Lighting from the front 
is not to be considered; if the light comes from 
the rear it blinds the teacher and increases the 
difficulties of supervision, but lighting from high up is 
not to be condemned and msiy have the advantage of 
illuminating the blackboard in front of the pupils. 
The desirability of light coming from both sides is a 
matter of dispute. If the aisle is located to the right 
of the room, the light from that side, even where there 
are windows to both sides, can not be as strong as that 
coming from the loft. In so far as the space on the 



24 SCHOOL HYGIENE 

righthand wall is not to be utilized for a door, or 
possibly for radiators and ventilators, it might be 
desirable to plan for windows above, in order to secure 
good ventilation. No disturbing shadows will be 
thrown by windows thus located. 

Windows. — The matter of the schoolroom window is 
not a simple one from a technical point of view. It 
goes without saying that the windows should be 
divided symmetrically and the spaces between should 
be as small as possible. A glance at the windows of 
the classrooms in Fig. 7 shows carefully studied 
construction. Broad frames not only take away 
considerable light in general, but they also especially 
darken the places of pupils sitting beneath, and much 
more so if the spaces between are used as wardrobes. 
Furthermore, the window must be rectilinear, rounded 
or pointed windows being entirely out of place in the 
classroom. The transom of the window should extend 
as far as possible to the ceiling, as in this way the 
angle of incidence of the light rays and the bulk of 
the direct beams will be increased. Window frames 
and intersections should be as small as possible and 
painted white. Window panes absorb quite a good 
deal of light, as Selter, in Bonn, has proved by his 
experiments; and this is particularly true of dusty 
windows. For this reason, the windows of the school- 
room should be washed frequently. It would be well 
to have double windows to insure warmth in winter, or 
at least in single windows to have two thicknesses of 
glass 5 centimeters apart. 

But the schoolroom window must also serve the 
purpose of airing. It is therefore necessary that 



THE SCHOOLHOUSE 25 

the windows should be such as to admit of being 
opened quickly and easily, especially the upper parts; 
the lower sections when opened must not hinder 
passage.* Sash windows are better than French 
windows for the schoolroom. 

Curtains and Shades. — In connection with the high 
and large window, arises the problem of curtaining 
or shading with a minimum loss of light. The 
shades must often be drawn when the window is 
open, and they should be adapted for this use; 
and they should be so arranged as not to admit ol)lique 
rays of light at the sides. The shades when not in 
use should fit into an opening made in the window sill, 
which is preferal)lc to the folded shade at the top of 
the window where it obstructs necessar}% light. 
Shades which can be rolled up tightly are not objec- 
tionable when placed at the top of the window. The 
shade material is of importance; it must be of good 
quality, plain (not striped), not too thick, white or 
cream-colored. Fine white shirting, light in quality, 
is the most suitable. The shades should be arranged 
in such a way that they can easily be taken off to be 
cleaned. 

Light Reflectors. — It might be possible to improve 
the hghting of old, badly built schoolhouses by re- 
constructing the window spaces, making them broader 
and higher, but because of the prohibitive cost, this 
is rarely undertaken after a schoolhouse is once built. 
Improvements in lighting may also be affected by 
the use of glass reflectors, such as the American 

* (The windows which are considered here are of the casement 
order exclusively used in Europe. Translators.) 



26 SCHOOL HYGIENE 

Luxfer prisms, or the French verres prismatiqueSf 
which are somewhat cheaper than the first named 
reflectors or mirrors. But in order to make these 
reflectors really serviceable, they must be kept 
absolutely free from dust. 

Artificial Lighting. — The discussion of lighting thus 
far has been with reference to daylight, but un- 
fortunately it is often not possible to depend upon 
that means alone, and artificial lighting must also be 
considered for the schoolroom. In the home it is 
possible to have the lamp on a table, to the left of the 
reader. It is not possible to give every pupil in the 
schoolroom an equal advantage, for a crowd of children 
must all have a free line of vision to the blackboard. 
How many children in brightly lighted rooms do we 
not see at work on their blank books in the deep 
shadow made by the book or the hand; that is, in a 
flood of light there are shadows just where the greatest 
intensity of light should be! Erismann of Zurich 
has found that an occupied desk did not have quite 
six percent of the light that fell on it when the desk 
was empty. But apart from this, unfortunately the 
light itself is not always of sufficient intensity, or 
it falls so that there is a glare in the eyes of the pupils 
as they glance at the blackboard. Further, the 
strength of the light depends as much on the distance 
as on the side from which it comes. It is also worthy 
of mention that some kinds of light have bad effects 
on the air of the schoolroom by generating noxious 
gases. 

Electric lighting, as well as lighting by Welsbach) 
lights, has done much to obviate such disadvantages. 



THE SCHOOLHOUSE 



27 



Kerosene or alcohol lamps are not desirable for 
school use because they require too much atten- 
tion. Modern lighting has achieved its greatest 
success in the electric bulb, which has enormously 
increased the intensity of available light with purity 
of the air and a minimum degree of heat and 
dryness. 

Diffused Lighting. — But the difficulty of overcom- 
ing, with any kind of direct artificial light, shadows 
made by the hands and bodies of the pupils still 
roinains. This disadvantage has been met by 

Jasper of Paris who dis- , 

covered a method for diffus- /"^j"^--^ 

ing light. For this plan of 
lighting, the ceiling and 
the upper third of the walls 
are painted a clean white. 
The lights are hung a short 
distance from the ceiling, 
about half a meter, and 
each lamp has underneath it 
an opaque shield which re- 
flects light on to the ceiling 
or on an upper shield, that Fig. 13.— Diffused lighting 
is, the lamp sends its light by Welsbach lamp, 
upward not downward. 

The utility of such lighting has been demonstrated 
in many localities. Fig. 13 shows a lamp designed 
by Egloff in Turgi (Switzerland). The advantage 
of indirect lighting is this, that the ceiling of the room, 
as well as the upper walls, throws the light in all 
directions, and while the intensity of light reaching 




28 SCHOOL HYGIENE 

the desk is somewhat diminished because a part is 
absorbed, the distribution is much more even than in 
direct lighting; and, what is still more important, 
there are no shadows. Such diffused lighting resembles 
very closely the daylight of a clouded sky. Be- 
cause of these advantages, indirect or diffused light- 
ing is being rapidly adopted in all places where the 
formation of shadows is a handicap. In the use of 
this light, at first the absence of shadows is confusing. 
That less light is needed has been demonstrated by 
the experiments of Prausnitz in Graz (Austria). 
In a classroom measuring 105 square meters, where 
the pupils were receiving instruction in drawing, 18 
Auer (Welsbach) lamps gave amply sufficient diffused 
light for the finest work. In the ordinary classroom 
there should be one Auer lamp for every 10 square 
meters of floor space; under such conditions, the 
light will be better than that supplied by an equal 
number of lamps with direct lighting. One dis- 
advantage, however, consists in this, that in dusty, 
sooty localities the white ceiling and walls, as well as 
the reflectors, quickly accumulate dust. The difficulty 
of cleaning is not insuperable if the person in charge 
of the cleaning is supplied with a small mirror 
adjusted on a long pole; but unfortunately, few 
janitors will bestow any care on surfaces over three 
or four meters from the floor. The lighting, of course, 
suffers a steady decrease in intensity as the room be- 
comes dingy. 

Direct Lighting. — Where direct lighting is used, 
lamp shades are necessary. It is well to have the 
shades large. If electric glow lamps are used they may 



THE SCHOOLHOUSE 29 

be fixed without shades directly on the ceiUng, for 
though the intensity of Hght is lessened somewhat by 
the increased distance, the diffusion is better and the 
shadows are less pronounced, as is proved by the 
experiments of Reibmayr in Innsbruck (Austria). 
With Auer lights and direct lighting, eye shields should 
be used.. Flickering lights should never be tolerated 
in schoolrooms. 

Gas Lighting. — -Gas lighting is unsatisfactory be- 
cause of the danger of unsuspected leakages which 
may deteriorate the air of the rooms and constitute a 
money loss as well. Absolute freedom from leakage, 
however, may now be assured by a small, inexpensive 
apparatus by means of which a daily test can be made. 
It is well to insert cocks at convenient places ^hen 
the building is in course of construction, as it may be 
practicable to turn off the gas supply in unused portions 
of the building and during vacations, thus preventing 
possible leakages. The main cock should be in an 
accessible place, not in the cellar. 

3. Ventilation and Heating 

Condition of the Air. — Dry air is composed of about 
79 percent nitrogen, 20.94 percent oxygen and 0.04 
percent carbon dioxide. The air as it comes from 
the lungs has about the same quantity of nitrogen, 
16.03 percent of oxygen and 4.38 percent of carbonic 
acid gas. Its oxygen content has thus been reduced 
about 20 percent, while the carbonic acid gas has in- 
creased 100 percent. In addition, small quantities of 
volatile substances have accumulated which tend to 



30 SCHOOL HYGIENE 

render a well-filled room unpleasant if there be no 
ventilation. The offensiveness of the room is in- 
creased when the occupants have not kept themselves 
clean nor provided themselves with clean undergar- 
ments (cf. school baths p. 63-64). It is difficult to 
demonstrate the presence of these volatile organic 
stuffs in chemical terms; hence von Pettenkofer in 
Munich took the quantity of carbonic acid gas in a 
room as an indication of the quality of the air. He 
claimed that air is injurious when the ratio of carbonic 
acid gas is over 1 per 1,000. Tests made in badly 
ventilated schoolrooms have revealed the presence of 
14.8 parts of carbon dioxide to 1,000 of the air in the 
room. In a crowded, unventilated room the carbonic 
acid increases after only twelve minutes to the maxi- 
mum, 1 to 1,000. This applies to a room where 4 
cubic meters of air space are allowed for each pupil. 
It must be mentioned, however, that von Petten- 
kofer's conclusions are open to question and that the 
experiments of Fliigge, made in his laboratory in 
Breslau (Germany), have shown results which are 
worthy of consideration. The human body constantly 
generates heat and must lose this heat if it is to 
maintain a constant temperature; i.e., it carries on 
unconsciously a system of loss of heat by conduction, 
radiation and water evaporation. When there are 
other bodies in close proximity, and these are also 
giving off heat and water at the same time, as we find 
in a schoolroom, the process of heat regulation is 
rendered much more difficult than it would be in the 
open air. The result is that in crowded rooms, heat 
accumulation takes place within the body, which in 



THE SCHOOLHOUSE 31 

turn produces pathological symptoms, such as a 
sense of oppression, and even syncope. The ex- 
experiments of Paul and Ercklentz in Breslau (Ger- 
many) have shown conclusively that with a high 
temperature (up to 30 degrees centigrade) and a 
high degree of humidity, the individuals in his test 
chamber soon showed these ill effects, while with a low 
temperature (below 20 degrees) and average humidity, 
such symptoms were altogether absent, even after 
two hours' stay in this atmosphere, notwithstanding 
the fact that in both cases the carbon dioxide content 
of the air was greatly increased — in the first instance 
to 13 per 1,000, and in the second as high as 16 per 
1,000. 

Hence it is clear that for general school conditions 
the temperature of the classroom should not be above 
20 degrees centigrade, at which temi^erature the body 
can carry on its processes of regulating heat most 
effectively. But even when the temperature is kept 
at the recognized standard, occasional thorough airing 
of the classroom should not be regarded merely as a 
secondary need. The increased carbon dioxide in the 
atmosphere decreases the exchange of air within the 
lungs. The work of the lungs is therefore lessened, 
especially as the children remain inactive. As the 
children sit quietly at their desks, they are constantly 
breathing in a good amount of the air which has just 
been exhaled, because respiration for all of them is on 
practically the same level within the room. For this 
reason we need fresh outdoor air. 

The presence of poisonous substances in expired air 
has not indeed been conclusively proved, although the 



32 SCHOOL HYGIENE 

investigations of Helwig of Zinnowitz (Germany) 
have shown that the bad air of unventilated, crowded 
rooms seems to have an influence on the red blood 
corpuscles, giving the cells an appearance of under- 
going degenerative changes. These characteristics 
of the red blood cells are not present under favorable 
conditions, i.e.j after bodily exercise in the open air. 
The investigations of Lobsien in Kiel (Germany) have 
likewise shown that breathing exercises have a 
favorable influence upon mental activity. 

As has already been mentioned, it is undesirable for 
children to sit in the schoolroom before the beginning 
of the session, when they can move about in a recrea- 
tion room, or better yet, may be exercising outdoors, 
as has become the rule in England. 

Dust. — Dust is another source of air deterioration 
and one which is being increasingly recognized. It is 
not well to keep children sitting for a long period of 
time, and yet when they move about the room they 
must stir up dust; for this reason, again, they should 
not come into the classroom long before school. 
Rooms must be cleaned and aired as often as possible; 
the air of even a clean room holds hundreds of organ- 
isms, while a dirty room contains hundreds of thous- 
ands to the cubic meter. The evil conditions that 
exist in many classrooms, so far as the presence of dust 
is concerned, have been brought out by the numerous 
investigations that have been made. Meyer in 
Leipsic, for example, found that with taking particular 
care to keep the shoes dusted, the quantity of dust 
which had accumulated from one bi-weekly sweeping 
to another equalled 191 grams in dry weather and 327 



THE SCHOOLHOUSE 33 

grams in rainy weather. Of the swept-up dirt a large 
part sinks to the floor after a quarter of an hour, but 
the finest dust requires from half an hour to an hour 
and a half to settle. In this dust disease may lurk. 

It is a noteworthy fact that many hygienists who in- 
vestigate the dust problem select the school as the 
most productive breeding place. From what has 
been said about the relatively long suspension of the 
fine dust particles in the atmosphere, it follows that 
dusting of furniture should not immediately follow 
sweeping, and also that the sweeping (which should 
never be dry) must not l^e undertaken shortly ])efore 
schooltime. 

Airing. — It is clear that the airing of the school- 
room bears an important relation to the health of its 
occupants. To have a constant interchange of 
air in the classroom would necessitate so large an 
accession of fresh outdoor air as to make the move- 
ment of air in the room plainly perceptible. This is 
mostly the case with artificial ventilators, and for 
that reason they are not always practicable. In the 
dwelling house with its relatively small number of 
occupants, conditions are different; there untight 
windows and doors often create unobserved channels 
of air. Even an unused stove and porous walls in 
themselves are ventilating agencies, which can be only 
slightly effectual in the case of the school. 

Direct airing is admirable, and can be readily 
achieved by opening doors and windows while the 
children are sent into the corridor. In cold weather 
a rapid exchange of air takes place in consequence 
of the difference of temperature. The air does not 



34 SCHOOL HYGIENE 

contain much heat, whereas the furniture of the room 
and its walls contain on the average about 1,000 times 
as much heat in the same cubic space; the room 
loses very little of its stored heat during a minute's 
exposure to the cold and a minute of thorough airing, 
or even half a minute, suffices in very cold weather 
to effect a renewal of air. If the heating is good, the 
remainder of the recess time of say a dozen minutes 
will be sufficient to warm the air; the breathing of 
colder, fresher air in a room where the walls and 
furniture are still warm does not jeopardize the health. 
Valuable experiments with this simple method of 
ventilation have been carried on by Dankwarth and 
Schmidt of Dresden. 

Ventilation. — During the summer or in warm 
weather, the windows of the schoolroom can well be 
left open if the situation of the building warrants 
it, but in cold weather artificial aids to venti- 
lation are necessary. The best is the so-called 
mechanical ventilation, that is by means of an ap- 
paratus worked by motors. This type of ventilation 
is practicable where the power, ^.e., electricity, is not 
too expensive. It is being used extensively in the 
United States, even in small schools, and also here 
and there in the higher schools of Europe. As has al- 
ready been mentioned, this method of ventilation is 
in use in the Drontheim pavilion school. 

In all artificial ventilation to bring in fresh air is 
preferable to taking out vitiated air by suction, for 
in the latter case the source of the incoming air is 
questionable. 

Even a small school can have its ventilating system 



THE SCHOOLHOUSE 



35 



and, if the directions for operation are to be found 
posted conveniently in the schoolhouse, there should 
be no trouble in management. One method is to have 
an air pipe, leading say from a garden, where the 
best air may be had, with the opening protected 
against mice and cats by a screen. This air pipe 
(L. Figs. 14 and 16) enters a stove, or more correctly 
speaking, enters between the 
stove and its outside casing or 
mantle, where the cold air be- 
comes warmed, and then flows 
into the room. The heated air 
being lighter naturally rises in 
the room and constantly re- 
places the colder strata. The 
used air in the room which is 
colder sinks and escapes through 
an opening in a corner near the 
floor (W, Fig. 15), not near a 
pupil's desk. This opening leads 
to a conduit going to the roof, 
where the used air finds an out- 
let. Of course, in summer the 
conditions are reversed; the 
clean air is then the cooler air, 
and the opening for the escape of 
the used air should be near the ceiling (S, Fig. 15). 
This vent (S) open in summer should be closed in 
winter when W is in operation for the exit of used 
air. 

This method of ventilating by means of temperature 
differences unfortunately has its weak side. It works 




Fk;. 11.— ihe Aleid- 
inger stove. 



36 



SCHOOL HYGIENE 



admirably in severe weather when the temperature 
contrasts are sharp, sometimes too well, because so 
much air comes in, that the opening will have to be 
closed to save using so much coal; but when little 
heating is required, the amount of fresh air admitted 
by the ventilator will naturally be correspondingly 
small. Moreover the upper vent (S) is of use only 
when the air of the room is warmer than the air out- 
side. It might be possible during warm weather to 
warm the air in the conduit which carries out the foul 
air by means of a gas jet or a lamp, thus aiding the 




Fig. 15. — Ventilation by temperature differences. 

process of air exchange. Since the air in summer 
streams in at doors and windows, the ventilation 
canal L (Fig. 16) could be dispensed with entirely 
without spoiling the air of the room, for if it were open 
it would simply admit air which would immediately 
escape through S, without circulating in the room. 
Scientific ventilation demands that the air in dusty 
places shall be filtered. 

Heating. — The essential requirements of all school 
stoves are that they shall be safe, shall not give too 
much heat, shall warm quickly and evenly, and be an 
aid to ventilation, not a source of bad air. To avoid 
the latter possibility, care must be taken to see that 



THE SCHOOLHOUSE 



37 



no part of the stove, including the oven, becomes too 
hot, for overheating causes deterioration of the air 
through action upon any dust which may fall on the 
stove or which may linger in the atmosphere about the 
stove, as has been demon- 
strated by Nussbaum in 
Hanover (Germany) and by 
von Esmarch in Gottingen 
(Germany). This deteriora- 
tion begins at a temperature 
of 70 degrees centigrade. 

Stoves. — Of the many dif- 
ferent kinds of stoves adapted 
for the schoolroom the Meid- 
inger deserves description. 
Figures 14 and 16 illustra,te its 
construction. There is acjd- 
indrical body with a firebox, 
Fu, composed of skeleton iron 
rings, a neckpiece H, with a 
door, the opening of which can 
be regulated laterally to con- 
trol combustion, and which 
can be opened from above like 
a lid for the removal of ashes. 
The coal (egg or small coal) 
is put in at F and lighted 
while Z is open. When the 
coal burns F is to be closed 
and Z opened laterally to regulate the heat as it is 
wanted. M and M' are the tin casings between 
which the warmed air ascends; if the vent S is closed. 




Fig. 16.— The Meidin- 
ger stove, interior view, 
showing ventilating sys- 
tem. 



38 SCHOOL HYGIENE 

FA will be open and fresh outdoor air then comes 
through the conduit L; this air circulates in the space 
between the stove and its casings. If S is opened, 
then the door FA closes the conduit L and only 
room air circulates between M and M', i.e., there is 
no ventilation whatever. This latter procedure, 
therefore, should only be undertaken before or after 
school hours; in very cold weather the regulator Z may 
be almost wholly closed after school ses^on, leaving 
only a very small slit-like opening so that the fire may 
burn the whole night through. This will insure a 
warm room in the morning, with a minimum consump- 
tion of coal. K is a little ventilation box which when 
open sends the air of the room directly into the 
chimney. This practical ventilating stove, which 
never needs cleaning for soot, may also be so placed 
that the firing and ventilation can be controlled from 
the corridor, as shown in Fig. 15, with the advantage 
that no fuel or ashes need be brought into the school- 
room. In that case, the outdoor air comes in through 
an opening in the outside wall, as shown in the plan, 
and enters the room at L (Fig. 15). To secure good 
management of the Meidinger stove, the directions 
for its operation should be easily accessible. Where 
the heating is by stoves, care should be taken in 
planning the school building to have a separate 
chimney for every stove. 

Gas Heaters. — The advantages of heating by gas 
have of late brought this method into popularity 
even in schools. The advantages are, cleanliness, 
convenience, and the ease with which gas heaters 
may be regulated as well as started and shut off; but, 



THE SCHOOLHOUSE 



39 



on the other hand, the cost of gas heating is often 
prohibitive. The ordinary gas stove used in the home 
is not adapted for the schoolroom, but a number of 
specially constructed heaters exist, all based on a 
special scientific principle. The attempt should 
not l)e made to introduce gas heating into old school- 
houses. Gas heating requires special, very narrow 
chimneys (10 centimeters wide) and the walls of 




Ficj. 17. — Steam heating. 

the chimney must be constructed of building materials 
especially adapted for this purpose, as the combustion 
of a oul:)ic meter of gas generates somewhat over one 
kilogram of water in the form of vapor which contains 
corroding chemical substances. With the old, wide 
chimney there is a possibility of the vapor settling 
on the walls, saturating them, and in combination 
with other products starting disintegrating processes 
in the chimney. 



40 SCHOOL HYGIENE 

Central heating by steam or hot water is the most 
practicable system for large schools. 

Steam Heating. — The principle of low-pressure 
steam heating is illustrated in Fig. 17. There is a 
boiler (V) in the cellar, from which pipes (M) lead to 
the various rooms, and radiators (R) give out warmth 
in the rooms. When the steam has again been pre- 
cipitated into water, it descends by means of other 
pipes (broken line). It is also possible to elaborate 
this system into the low pressure hot-air steam heat- 
ing by using the steam from the boiler in the cellar 
to warm a big heater which receives fresh outdoor 
air through a vent, warms this air and sends it by 
conduits to the rooms. In particularly cold rooms, 
separate heaters, all supplied from the same boiler 
in the cellar, may be set up. This system has re- 
placed the old-time hot-air heating, which possessed 
the disadvantages of carrying, in addition to the 
warmed air, various gases generated by the burned 
dust, and when the brickwork of the furnace became 
loosened, also smoke into the room. Ventilation, 
however, is nicely secured in the case of low pressure 
steam heating by means of fresh-air conduits which 
bring the air from out of doors directly to the registers, 
where it is warmed and sent off into the rooms. 
This plan does away with the old difficulties ex- 
perienced with the combined hot-air heating and 
ventilation. 

Hot-water Heating. — The requirements for hot- 
water heating are similar to those for steam. As 
shown in Fig. 17, the water is heated in the boiler, 
it ascends by pipes to a tank on the upper floor, 



THE 8CHOOLHOU8E 41 

goes from there to the rooms, giving off warmth, and 
sinks back to the furnace. The advantage of the hot- 
water system is, that the radiators retain their heat 
longer than with steam heating; but the cost of in- 
stallation is higher, and there is the possibility that 
the water in tlie pipes may freeze in winter, es- 
pecially during the Christmas vacation. Recently 
a device has ])een invented for the more rapid cir- 
culation of the water in the pipes. 

One point in connection with central heating is 
important; there must be no niggardliness or stinting 
in installation. Furthermore, the person in charge of 
the heating should be Tjompetent and intelligent, per- 
manently emi)loy(Ml, not one temporarily engaged 
who is obliged to seek other work in summer, l^etter 
employ a man the whole year, in summer time for 
cleaning in the schoolhouse, and engage a new person 
for cleaning purposes in the winter. To achieve the 
best possible management, the heating and lighting 
arrangements should be sul)ject to the direction of 
one who can give intelligent and expert supervision, 
as for instance, the instructor in physics. The com- 
fort of the school population depends upon properly 
managed heating, lighting and ventilation, and 
the significance of these from the standpoint of health 
is paramount. 

4. The Classroom and Its Equipment 

Much of what has been said before underlies, rein- 
forces and will be repeated to good purpose under this 
heading. The whole question of classroom arrange- 



42 SCHOOL HYGIENE 

ment is so involved and interactionary that it is not 
always possible to isolate and discuss separate aspects 
of the problem. 

The most serious hygienic consideration with regard 
to the school is this, that a relatively large number of 
individuals must be confined for a considerable period 
of time in one room. When we ask, what shall be 
the size of that room, the answer hygienically con- 
sidered must be, the larger the better, because of the 
better air. But practically, the size of the classroom 
is determined by the following conditions: the carrying 
capacity of the instructor's voice, the distance at 
which the desks can be placed from the blackboard, 
and the number of pupils which a teacher can instruct. 
The width of the room is controlled by the amount 
of light which penetrates to the farthest desk. The 
greater the width, the higher must be the ceiling, 
but the higher the room, the more difficult it will be 
to heat, and the greater will also be the cost of 
construction. 

Size of Classroom. — Considering all these condi- 
tions, it is safe to conclude that a classroom 9 meters 
long, 6 meters wide, and 4 meters high, is most 
practicable. In a room of these dimensions 50 pupils 
can be seated in good-sized, two-seated benches (cf. p. 
89, also Fig. 18) ; that is really a large number and a 
greater can not be accommodated with comfort. Un- 
happily, conditions as we frequently find them lapse 
far below this ideal, to the detriment of teacher and 
pupils. In many highly cultured communities, mat- 
ters of expense and equipment are still patterned after 
the demands of a time which included no hygienic 



THE SCHOOLHOUSE 



43 



considerations. It is not always possible to recon- 
struct; hence it can not be too emphatically urged that 
in young communities which are still in the period of 
forming and developing their school systems, these 
matters should receive careful thought, in order that 



r-o 



L 



0-5 



5m 



Fig. 18. — Plan of a schoolroom witli benches each accomodat- 
ing two pupils. 

sufficient funds may be appropriated to carry out such 
hygienic plans. 

The most desirable ratio of length to the width of 
the schoolroom is 3 : 2. Of course, the limit of 9 



44 SCHOOL HYGIENE 

meters for the length of a room applies only to class- 
rooms where the voice of the speaker plays the im- 
portant role; it does not hold for rooms where draw- 
ing is taught or for gymnasiums, where height and 
width are more, or at least equally important. 

Walls and Ceiling. — All corners, those of walls and 
ceiling, walls and the floor, should be rounded, in 
order to facilitate cleaning. The walls should be 
tinted a neutral tone, preferably a light green, the 
upper third whitened to augment reflected light, and 
the lower section, about IJ meters from the floor, 
finished in a durable material, for instance in tiling, as 
is done in London schools, or in cement, which may 
be painted with oil paint. The ceilings should be pure 
white. A preparation can be used for disinfecting 
the walls that is said to retain its efficacy for a 
considerable period. 

Floor. — The floor should be durable, well joined, 
not dust retaining, and easy to clean. Soft wood is 
to be condemned; it splinters, gets into the mops, and 
is a continual harborer of dust. Hard wood should 
always be chosen. Prepared beech wood and Ameri- 
can pitch pine are to be recommended; they are 
cheaper than oak, which, of course, is the most durable 
of all. When laid in the usual mosaic pattern these 
woods will give good wear. If the floor planks have 
joints which do not fit tightly, the yawning places 
should be scraped and trowelled with a mixture of 
fresh curds and slaked lime in the proportion of five 
to one. The result is a casein cement with lime, 
which is as hard as stone, and impermeable to water. 
Any coloring, for example, ochre, may be added. 



THE SCHOOLHOUSE 45 

Unless this is done, the openings will harbor moisture 
after every cleaning, creating a situation favorable 
for the breeding of bacteria and vermin. 

Ordinary wood floors require surface treatment. 
The cheapest way is to have the floors thoroughly 
washed and dried and then painted with a thin coat 
of coal tar. This tar can be procured at any gas plant 
and can be applied after warming over a gentle flame, 
not more than 40 degrees centigrade, and since it 
must have that temperature when being applied it is 
best to keep the vessel during use in a kettle of water 
at 40 degrees. As the tar retains its odor for some 
time, the work should be done during a school vaca- 
tion. The oiling of floors is to ])e recommendecl, for 
good specimens of dustless oils have proved effectual 
in holding down the dust, which the movements of 
the children otherwise keeps in circulation. In clean- 
ing, the dust is swept into little balls by means of a 
hard broom. The oiling must be renewed three times 
a year or oftener if there is a great deal of dust. But 
notwithstanding the great hygienic value of oiled 
floors, they are not popular with women teachers 
who wear long skirts. This nuisance to the teachers 
could be avoided in some measure if a definite area 
around the teacher's seat were left free from oil. 
Again, footprints show very easily on the clear surface 
of the corridors. Because of these drawbacks, floor 
coverings such a Xylolith or linoleum are sometimes 
chosen. Xylolith would serve the purpose well for 
it is able to withstand wear, but it is not a good conduc- 
tor of heat and therefore makes the floor too cold. 
Linoleum, which is a mixture of cork and oxydized 



46 SCHOOL HYGIENE 

flaxseed oil with resin and coloring matter added, 
makes a very good floor covering, but it is expensive 
and it requires care: the padding underneath must be 
very smooth and quite dry and the linoleum, which 
should be of a good firm quality, must be absolutely 
dry before it is laid. 

The School Desk. — The bugbear of school hygiene 
for a long time has been the school desk, or the desk 
form, as it is called in England. Naturally, the first 
requirement is that the desk shall be adapted to the 
user and yet allow him a good deal of freedom in 
movement. The child must be able to assume a freer 
posture in reading than while writing, when he must 
necessarily be in a somewhat cramped position; he 
must be able to stand up and sit down with comfort, 
to get in and out without difficulty. These matters 
are of prime importance. But the attempt to enforce 
good posture solely by means of the school desk must 
be abandoned at the outset. The desk should not 
have sharp corners, which may cause bruises. It 
should be such as not to render cleaning difficult, nor 
should the forms be of a shape to interfere with the 
teacher's vision of the pupils, and lastly, the desks 
should be practically noiseless. After conforming to 
these requirements, it is essential that the desk form 
does not take up too much room, nor must it be too 
expensive. , 

To maintain a sitting position for a long period of 
time is in itself unhygienic, particularly for children; 
to sit long in an upright position requires constant 
effort, even for adults, and the difficulty is increased 
when the child is sitting on a bench which is not suited 




FiG. 20. — Moulthrop movable and adjustable school chair, 
Model B, inaimfactiired by Langslow, Fowler Co., Rochester, 

N. Y. 



THE SCHOOLHOUSE 47 

to his height. In consequence, he is obliged to as- 
sume positions which can not fail to be detrimental to 
health, i.e., the development of the thorax is hampered 
and there is interference with respiration, circulation 
of the blood, and digestion, besides possible injuries to 
the spine and the eyesight. It should be the serious 
aim of the school never to be the cause of any such 
injuries to health. To overcome the difficulty of 
long sitting it has been advocated that alternate sitting 
and standing be the rule in school, and certain types of 
German, French and American desks (cf. Fig. 20) 
which can be readily converted from sitting into 
standing forms are available. But long standing is 
even more fatiguing than sitting, and is not 1^ be 
recommended. Fig. 20 has a sliding desk top which 
can be pushed aside at will, thereby allowing the 
child to stand immediately and without difficulty.* 
Let us assume that a new schoolhouse is to be built 
on the site of an old one. In order to have the new 
desks of the right dimensions, the children of all 
classes ought to be measured before the desks are 
ordered, and the new school furnished with desks of 
various sizes to fit the children. At the beginning of 
the next school year, the previous assortment of desks 
in the rooms will probably not answer the purpose 
very well, the assortment of children will be differ- 
ent each 3'ear and there may not be as many chil- 
dren of a certain size as there were in the previous 
year. If one mixes them again in the second half 

♦This model, the Moulthrop movable and adjustable school chair, 
is made by Langslow, Fowler Co. (United States), and is indorsed 
by Madame Montessori iu her school methods. 



48 



SCHOOL HYGIENE 



8 



175 



and 




6 




year and compares their sizes with the various sizes of 
school desks, it will be found that a number of children 
in the age of rapid growing have grown out of their 
standard of desk. Even in small country towns the 
desks of the school should certainly not be ordered 
before the children have been meas- 
ured, and if possible, measurements 
should be made at the beginning and 
the middle of the school year. Un- 
fortunately the selection of the desk 
sizes is frequently left to the manu- 
facturer. 

Under favorable conditions a half 
yearly measuring of the school popu- 
lation and seating according to the re- 
sults found is excellent; it is a con- 
venient, easily to be obtained, and 
H{Bl26-13't ^^om the point of view of health a 
^^^ A reasonable exaction. The work can 

^-\,^ be done very quickly by means of a 

?lZ6c.ni. measuring rod, which the author de- 
f I scribed in 1896 and recommended for 

manufacture. Fig. 19 shows one of 

these rods designed for use in the 
schools of Vienna. The measuring 
stick must have divisions marked 
off for the various sizes of desk; the 
teacher records opposite the name of the child the 
corresponding size of the desk. Duf estel of Paris has 
constructed a measuring stick which automatically 
records the height of the pupil in millimeters. 

If it is found that in one classroom there are desks 



165-17^ 



Ibb-m 



Ikb-lbk 



135-M 



Fig. 19.— 
Measuring rod 
numbered for 
the various sizes 
of desk forms. 




Fio. 21. — The "Princctoir' a(ljusta))lc desk and chair, 
niaiiufactuied l)y The New Jersey School-Church Furniture 
Co., Trenton, N. J. 



THE SCHOOLHOUSE 49 

which do not fit the children in that room, the desks 
should be exchanged for others obtained from other 
classrooms. 

Adjustable School Furniture. — The ideal desk is one 
with adjustal^k! parts and which can ])e fitted to the 
child. Such single desks (Fig. 21 and 22) are used in 
many schools in Great Britain and the United States; 
or where their exclusive use is not prescribed, the 
requirement is made that at least one-third of the 
desks in the new school shall be of this type. Adjust- 
able school furniture has also begun to be introduced 
in Germany, and is being used in a small number of 
schools in conjunction with the older type of desk.* 
Desks which can be adjusted without a screw or key 
(Fig. 22) are better than those for which an implement 
is needed. One of the oldest adjustable desk forms is 
that put on the market by Hansen in Copenhagen; 
it has a movable foot rest to adjust the height 
of the seat to the body of the pupil, and a 
movable back to adjust the ''difference" and the 
depth of the seat. This type of desk has given 
good service in a number of schools of Denmark and 
received high commendation in a report of the Danish 
school health commission (1884). 

In secondary schools, where the classrooms are not 
always used for the same grade in succeeding years, or 
in schools where they are made use of for different 
purposes — for adult evening classes, assemblies or for 

* Adjustable desks are produced in Germany by Elsasser, 
Fuhrmann & Hauss, Kottmann, Lickroth & Co., Zachokke; in 
the United States by the New Jersey Sohool-Church Furniture 
Co., the American Seating Co., and others. 



50 SCHOOL HYGIENE 

entertainments — the adjustable desk is by far the 
best, especially if it can be quickly arranged. A new 
model from a London manufacturer is made of 
wood, is adjustable by means of springs in the 
legs of the desk and bench, and is arranged so the 
top can be pushed away or brought nearer to the 
body. The correct height of desk and seat can be 
secured very simply by pressure upon the spring 
and then raising or lowering the parts in question. 
When a desk of this type is used, there is no need 
of taking measurements and notes; the older 
children especially do not require much instruction in 
adjusting, with the help of a fellow student, the desk 
and chair to suit them. The charm of newness which 
makes the pupils want to play with these adjustable 
desks will not last long; children do not want to play 
with ventilation valves or windows or doors although 
these things are movable toOi This difficulty will be 
lessened if the children are not admitted to the room 
before beginning of class nor during recess periods 
when the teacher is not present. 

Aside from these and other newer desks, the non- 
adjustable desk forms are used a great deal in Europe, 
and from three to ten different sizes may be pro- 
cured. There are hundreds of models on the market. 
When the desk can be found in a greater number of 
sizes, say from eight to ten, it is easier to choose a 
more fitting size for the body than if there are only 
three sizes of desks, but the practical difficulties ex- 
perienced with so many different sizes are increased. 
If a teacher has a room with desks of different sizes 
which are not bought after the above described meas- 



Horizontal Adjustment of Top at will of occupant. 

Adapted to varying uses. 

The only scientific and practical Plus and Minus ad- 
justment. 

Top has Horizontal Adjustment of 354 inchies. 

Inkwell exposed when top withdrawn for writing; 
covered and protected when top returned for study. 




Vertical ad- 
justment of 
Chair Seat 

Top of Seat 
from Floor: 

No.l.lS.^^'tolS" 
No.3.16'tol2>i" 
No. 5. 13 '<: "to 11" 
Not adjusted 
by occupant 



AMERICAN STEEL ADJUSTABLE BOX DESK WITH SLIDING TOP 

CHAIR EQUIPPED WITH ADJUSTABLE BACK SUPPORT 



Fig. 22. — Adju.st:il)le desk and chair, manufactured by the 
American Seating Company, Chicago, 111. 



THE SCHOOLHOUSE 51 

uring of pupils, nothing can be done but to distribute 
these desks according to their dimensions, form the 
pupils in a row according to their height, and seat 
them in that order in the desks. Special attention 
must always be paid to the nearsighted and the deaf. 
The resulting arrangement, the best possible under 
those circumstances, is naturally not always satis- 
factory. 

Desk Dimensions. — It only remains to say a few 
words al)out the coni^tituent parts of the school form 
and their relations to one another. The seat should 
be just so high from the floor that the upper part of 
the leg is horizontal and the lower part perfectly 
perpendicular when the foot is placed firmly on the 
floor. If the seat is too high, the nerves and nblood 
vessels on the under part of the thigh are compressed, 
particularly those near the edge of the seat, and the 
child is apt to slide forward and to lapse from the 
erect posture. If the seat is too low, the thighs 
will be pressed against the abdomen. The depth of the 
seat, i.e., the distance from the forepart to the rear, 
is influenced by the length of the th'gh; the depth 
must be such that the child's back reaches the back 
rest, a support of two-thirds of the thigh is amply 
sufficient. The position is firmer when the seat is 
slightly curved as shown in Fig. 23. 

The level ot the desk top should be in the plane of the 
sitter's elbow when the arm is hanging down. If the 
top is too low, the child must bend down to write, 
assuming a position which is injurious to the spine, 
the chest, and to the respiratory and digestive organs. 
If the desk is too high, he uses his eyes too near the 



52 



SCHOOL HYGIENE 



work, and the arm can not be held near enough to the 
body when writing. The question of the tilt of the 
desk will be considered later. 

The back rest is absolutely necessary because a 
child can not sit for any length of time without 
some support. The rest may be of various heights, 
but it should at least support the lower third of the 
spine. At this point we reach a real difficulty, for 

if one surveys classes of 
children, in a school, one 
notices how seldom the back 
of the seat is used as a sup- 
port. The fact of the matter 
is that a back rest is comfor- 
table only when tilted back- 
Avard to a considerable degree, 
as in an easy chair; but if 
this were done in the school- 
room, the seat must also be 
tilted correspondingly (Fig. 
23) in order to insure firm 
seating. Furthermore, the 
desk would then have to be 
tilted, otherwise there would be a strain on the 
eyes, for a great angle of vision is unbearable, while 
one of about 8 degrees requires no strain whatever. 
When reading, the pupil may hold the book in his 
hand, that is, in a tilted position; but in writing the 
tilt of the desk can not be so readily adjusted. The 
desk top can not be tilted too much, otherwise the 
arm must be held in such a way that the ink will 
not run from the pen. This would be very tiring 




Fig. 23.— a desk de- 
signed by A. Lorenz. 



THP] SCHOOLHOUSE 53 

to the arm, even for a short time, but should there 
be no possibility of change it would be unbearable. 
The tilt of the seat involves many other problems. 
The best back rest has a uniform slant. Ortho- 
pedists formerly recommended a projection to curve 
into the lower part of the back, until Schulthess of 
Zurich showed that in a sitting posture the natural 
curves of the spine are not as pronounced as in stand- 



+ - . 

% 

Fiti. 24. — Di-staut'cs hetwocn seat aiul desk. S — scat, 
D = desk. The cut to the left shows phis distance, the 
middle mdl distance and the one to the right minus distance. 

ing. Recently, Piesen of Prague has shown that 
this wooden projection may do absolute harm to 
children; in a number of children so placed albumin 
was occasionally found in the urine. Howev^er, a back 
rest is absolutely needed for the support of the lum- 
bar region of the spine. 

If as in Fig. 24 a perpendicular dotted line is dropped 
from the edge of the desk (D) to the floor, this line 
will meet the edge of the seat (S), or go to either 
side. This dotted line constitutes the ''distance.'' 
It is immediately clear that what is denoted as ''plus- 
distance" is bad because it demands bending forward 
during work, while the "minus-distance" is the proper 
one for writing, but restricts the movements in other 



54 



SCHOOL HYGIENE 



occupations and prevents the child from standing 
up. To meet this difficulty, distance adjusters have 
been designed in order that the bench can be so placed 
as to permit the child to write at minus, and to sit 
at plus distance from the desk; the latter distance 
also permits of easy standing up and ingress and egress. 
The value of a school desk is greatly increased by these 
distance adjusters; schools which are putting in new 



« 




"V-......, 




Fig. 25. — Movable desk top by 
Schlimp. For writing it is inclined 
in the dotted line a, 6 ; at other times 
it is in the line cd. The change is 
made easily and noiselessly by the 
joints, /,s^,/c,^. 



Fig. 26.— a readily 
adjusted seat designed 
by Schenk. 



furniture should install only desks so equipped. The 
distance may be adjusted in various ways; the 
desk top may fold on itself (Fig. 27), or it. 
may be pushed forward or backward (Fig. 23), 
or drawn out and pushed back again (Fig. 25);* 
or the seat can be turned up and put back, or moved 
forward and backward like a pendulum (Fig. 21 and 

*A model possessing distance adjusters in the desk is shown in 
Fig. 25, It was invented by Schlimp Brothers (patent expired), 
and is much used in Austria. It is one of the many modifications 
of the original adjuster designed by Kunze. 




Fig. 27. — Single pedestal desk coinbination, manufactured by 
Kenney Bros. & Wolkins, Boston, Mass. 



THE SCHOOLHOUSE 55 

26). The seat adjustment merely makes i^oom for 
the pupil to' rise, but does not influence the sitting 
distance. It is essential that these adjusters should 
be tolerably noiseless and also that they be of such 
construction that they do not act as traps in which 
the hand may be caught and pinched. An adjuster 
like Fig. 25 has the advantage that the pupil when 
writing can easily set the desk at minus distance, and 
during the writing pauses can push the desk away 
from him for greater freedom in movement. 

But still the ''distance" referred to above does 
not entirely solve the question, the really significant 
distance being that between the slanting back rest and 
the desk edge. For writing, this space should be a 
few centimeters greater than the body thicKuess at 
the chest; it should correspond to the length of the 
forearm. 

The low desk forms of small children are a tax on the 
teacher, who must bend over to see the work. For 
this reason such desk forms should be placed on a 
pedestal or the form should be quite high, with a 
footstool to make the child comfortable. The 
footstool has a disadvantage in that if the desk 
has no movable ''distance" and the child wishes to 
stand for recitation he must first step out. Experience 
shows that this inconvenience frequently results in 
the teacher not requiring the pupil to rise, and the 
child thus loses the opportunity for exercise gained by 
the change of position — a distinct disadvantage from 
the standpoint of hygiene. 

In the non-adjustable desk forms each desk should 
be attached to its own chair, not a chair to the desk 



56 SCHOOL HYGIENE 

behind, so that when shifting the furniture a chair 
will always correspond to its own bench. It is better 
to have non-adjustable desk forms which accommodate 
but two pupils, for with desks accomodating only- 
two, each pupil can step in and out, and the teacher 
can pass each place — a condition which does not hold 
for forms accommodating more than two pupils. 
The use of desk forms accomodating not more than 
two children has been prescribed by law in Sweden 
since 1878. 

Movable Desks. — To facilitate the cleaning of the 
floor, many ways have been suggested and one of these 
is to make the points of contact of the desk with the 
floor as few and as small as possible (Fig. 27). The 
idea has been developed in the United States and in 
France since 1877 under the ''Mittelholm" principle. 
In some places double-seated desks were merely 
turned over at cleaning time; this was first done with 
the Roux desk in 1887, in the Villamont School at 
Lausanne (Switzerland), and is still done in many 
other places. In 1893 Rettig patented a movable 
desk (similar to desks shown in Fig. 28) and in 1900' 
Zollinger of Zurich introduced the idea of having whole 
series of desks on casters, so that they can be readily 
moved out of place. Different sorts of appliances 
for rolling the forms have appeared in Switzerland, 
Austria and Germany. One plan is to have the rollers 
of the desks coupled together (Fig. 29) ; another plan, 
first suggested by Baudin of Geneva, is to have a whole 
line of desks on an iron rail (Q) in which the rollers 
are set (Figs. 30 and 31) . This plan of rolling away the 
benches when cleaning the floor is decidedly the best, 




Fi(i. 2.S.— Benches (Urania) designed by Piasecki, turned 
for cleaning the floor. 



over 



THE SCHOOLHOUSE 57 

for with a clean sweep of floor there are no inaccessible 
places. It is easier to push the tiers to one side than 
to turn one desk over the other, at the same time there 
is no danger of spilling the ink, although the reversible 
desks do have special inkstands which when carefully 
handled can be turned over also. All kinds of desks 
with movable parts are better pushed than turned 
over; furthermore, iron desks, also can be rolled but 
they would be too heavy to turn. 

The question as to the injury which such roller 
benches may sustain from the children playing with 
them has already been rais- 
ed. The author personally 
does not knowof any such 
instances though he has in- 
quired concerning this point 
in places where such desks 
are used. The outer edges 

of the large projecting roll- ,. on t^ n i j 

/T^- r.V.N , Ti , 1 i<'- 29.— Rollers coupled 

ers {t Ig. 29) should be togethor for rows of benches, 
rounded off so that the designed by Walter. 

floors will not be scratched. At the Dresden Inter- 
national Exhibit a contrivance* was shown whereby 
the benches when in use stand without rollers, but 
are readily put on rollers at cleaning time. 

When three tiers of benches are pushed away, a 
large floor space for exercise can easily be had (Fig. 
31); this would be impossible with stationary benches, 
or those which can only be turned over. In the United 
States gymnastic apparatus are arranged on rollers 
in a similar way. 

*This contrivance is manufactured by Lickroth & Co. 




58 SCHOOL HYGIENE 

Posture. — Associated with the problem of seating 
is that of a correct sitting position. Where a school- 
room is equipped with practicable desk forms, a hy- 
gienic posture should be urged upon the child frord 
the outset. A definite amount of time should be 
allowed for acquiring a good position at the desk. 
Beginners, for instance, should not be required to 
assume the correct writing position for more than a 
fraction of an hour, being permitted during, the re- 
mainder of the time to assume an easier attitude, for 
to maintain a correct posture means considerable 
work for their muscles. Parents can help by admoni- 
tions at home and also by purchasing the right kind 
of a house desk which the shops offer in a variety of 
forms, or proper provisions can be made by means of 
a footstool and an upholstered chair. Many me- 
chanical means have been designed for helping a child 
to maintain an erect posture. The subject can not 
be discussed here in full, but mention should be made 
of a device sold by Iberg in Basel. This is the Bril- 
lenger.adehalter, a spectacle frame with two black cellu- 
loid flaps, which fall down over the eyes when the 
pupil bends over, but which adjust themselves and 
uncover the eyes when he straightens up. Another 
useful and inexpensive device is that introduced 
in the Guts-Muthsrealschule of Quedlinburg by H. 
Lorenz. It is a light metal ring, about 20 centimeters 
in diameter, which slips from the head of the child 
when he tilts his head too far forward or too far to 
one side. The term Geradezwinger (upright forcer) 
does not convey a pleasant meaning, and its use 
would be objectionable if the teacher should forget 




YiG. 30. — A sclioolroom in Ck'iiova with three rows of two- 
seated benches designed by Mauchain. The benches are placed 
on the Baudin rollers. 




Fig. 31. — The same room as shown in Fig. 30. The rows 
of benches have been moved close together, to give a large 
free floor space. 



THE SCHOOLHOUSE 59 

to pay attention to the fact that the child can only 
bend his head forward a short distance, and the 
contrivance may overtax the child's back and neck 
muscles. 

Blackboards. — The ])lackboard should be of a dull 
finish, not too highly polished, and so placed that in 
looking at it the children will not be dazzled by light 
from a window. Large shiny blackboards on the wall 
opposite the windows are likely to take away much 
reflected light, as has been shown by Gstettner of 
Vienna, therefore dull ones would be more suitable. 
An antiseptic blackboard, which resembles an oilcloth 
scroll, has recently come into favor in New York City 
schools. 

Lavatory. — If the chiklren use chalk the>* should 
have a place where they can wash their hands. It is 
most desiral)lc to have the lavatory in another room, 
in the cloak room, the recess room, or the toilet, as has 
already been discussed. 

Expectoration Receptacles. — The question of dis- 
posing of the expectorations of the children is a more 
difficult one. Covered cuspidors attached to the 
walls are better than those placed on the floors. It 
seems hardly necessary to say that expectoration on 
the floor should never be tolerated. Children who 
have to expectorate should be placed near the cuspidor, 
so that when necessary they can step to it without 
causing a disturbance. Since Dettweiler devised an 
individual saliva cup, many others have been sug- 
gested. The question whether it would be better to 
provide these for the coughing pupils or to require the 
parents to furnish them for their children is no difficult 



60 SCHOOL HYGIENE 

matter to decide by experimenting; but a highly cul- 
tured public is generally disinclined to discuss matters 
of this sort. 

5. Other Rooms, Grounds, and Facilities of the School 

Gymnasium. — From the standpoint of hygiene the 
gymnasium is most important. It must be well 
lighted, convenient, easily ventilated and suitably 
heated. It should not be located in the basement. 
The apparatus must at all costs be safe and the 
wood work should not splinter, for serious injuries or 
even fatalities may result from neglect of these 
requirements. To see that such matters were at- 
tended to, in 1895, the government at Sigmaringen 
(Germany) ordered a yearly inspection of gymnasium 
apparatus. The greatest problem existing in the 
gymnasium is the presence of dust. For this reason, 
the children should not be allowed to enter in their 
street shoes, nor should the mattresses in the gym- 
nasium be allowed to become dust receptacles, which 
is hardly possible to avoid with cheap kinds. 

The floor covering must be good (for instance, strong 
linoleum), and not slippery. The use of floor oils has 
been decided against by some teachers though it is not 
generally objectionable, for the gloss will disappear 
after once using the floor and the oil when thinly ap- 
plied can hardly be a source of danger. It is to be 
recommended that in winter when much dust may be 
brought in and no precautionary measures for its 
prevention are taken, those exercises which would 
cause a dissemination of the dust be omitted. The 
author has had occasion to inspect a new gymnasium 



THE SCHOOLHOUSE Gl 

in a large city where no oil was used on the floors and 
no special shoes were worn by the children, and where 
such unhygienic conditions existed as to make the 
work in the interest of preventing tuberculosis a 
derision. This state of affairs in gymnasiums is all 
the more remarkable since von Pirquet has proved 
that a verj^ high percentage of children is infected 
with tuberculosis, even though the infection seldom 
reaches a dangerous stage. The question, then, may 
well be asked — how can a teacher manage to keep the 
room free from dust, when the streets are dirty and 
oil is not used on the floors, and no change of shoes 
on the part of the children* is required? Even 
when care is taken to wipe the shoes at entrance, it 
is impossible to exclude all dust. In view of tnis fact, 
it seems neglectful to do without floor oil. 

The gynmasium should have its own cloak room, a 
convenient, indoor toilet, and if possible, its own 
lavatory. Physical exercises carried on in the open 
air are preferable to work in an indoor gymnasium, 
for conditions in the open air are better adapted to 
meet the increased demand made upon the lungs. 
Hence, an open-air gymnasium situated in the school 
grounds partly roofed over, but open at the sides, is 
ideal for this purpose. In a large school, when choosing 
the site for this outdoor gymnasium, it should be re- 
membered that close proximity to the classrooms may 
disturb the work of instruction. Such details are all 
directly connected w4th the planning of the building. 

Playgrounds. — In this connection the general prob- 
lem of the recreation place comes up for discussion. 
The recreation room has already been briefly spoken 



62 SCHOOL HYGIENE 

of and the indoor and outdoor gymnasiums have 
been mentioned in the preceding paragraph. In every 
case, a place in the open is very desirable where 
pupils can spend their free time when the weather 
permits and when waiting for school to begin. A 
playground should be as large as the available grounds 
permit; in small towns at least 5 square meters 
should be allowed for each child, and in even the 
smallest rural communities the total play space 
allowed should not be less than 200 square meters. 
In the most populous parts of large cities, the minimum 
should never be less than 1 square meter per child. 
The difficulty may be met in part by using the roof, as 
is done in London and New York. Fig. 32 shows the 
roof playground of a school building in New York as 
designed by Snyder. These roofs are used in that 
city on hot evenings as recreation places for mothers 
and children. 

Where it is possible to have the yard large enough 
to be used as a playground and as an ice field in winter, 
for instance in the smaller towns, a good step has been 
taken toward the healthy rearing of children. In the 
crowded districts of large cities where it is not possible 
to have the playground next to the school, the aim 
should be to provide an open space elsewhere for the 
children of each school, one easily accessible by car 
lines at a minimum rate of transportation, plus a short 
walk. 

The way of progress in the matter of the play of 
children has not been easy in Europe during the past 
generation. It is a long step from the epoch of the 
decree of 1882, effected by the Prussian Minister of 



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THE SCHOOLHOUSE 63 

Education, von Gossler, to the requirement of a 
definite afternoon per week set aside for play. 

School Gardens. — A school garden, where it can be 
had, is to be recoinnicnded from the hygienic stand- 
point. It serves when next the schoolhousc to keep 
the air pure and affords opportunity for healthful out- 
door occupation. 

School Baths. — Ainong the many products of school 
welfare work, the school bath takes high rank, be- 
cause of its hygienic significance. To the city of 
Gottingen (Germany) ])elongs the credit of having 
introduced, twenty-five years ago, the first school 
baths, an example which has since then been widely 
followed. The need for this extension of the field of 
education is shown by the following extract fi%m a 
Gottingen report, ''We state the shocking fact that 
with the exception of the face and hands, not a drop 
of water touches year after year the bodies of a 
great majority of the pupils in our German schools." 
Naturally, the argument is frequently advanced that 
these are not matters of the school, but rather of the 
home. It is an argument that needs constant refuta- 
tion by the statement that very possibly in an earlier 
time the present and generally recognized right of the 
state to impose compulsory education, may have 
been regarded in the same light in which obligatory 
cleanliness is now viewed. 

The school bath referred to above is the shower bath, 
which requires little room, and not much heating or 
water. It can be arranged that groups of children 
go to the baths at such times when a part of the class 
can be absent, for instance, during a penmanship 



64 SCHOOL HYGIENE 

period. The baths may be placed in a well-hghted 
basement and should have a dressing-room large 
enough to accommodate a number of pupils, who can 
undress while others are bathing. For the actual bath 
the water is first run warm (35 degrees centigrade), 
soft liquid soap is applied and the body is washed and 
rinsed in a temperature which gradually decreases 
toward 20 degrees. A bath of this kind requires five 
minutes of time, about 20 liters of water for each 
pupil and costs perhaps half a cent per person. The 
process is a rapid one — a new troup of children goes in 
as soon as the other comes out of the room, and un- 
dressing, bathing and dressing follow in quick suc- 
cession. Thus a maximum amount of benefit is 
obtained at a nominal cost. The bathing should be 
done under the supervision of a teacher, and if nec- 
essary, an assistant might help the small children with 
their clothes. 

The general practice with regard to these baths has 
been to leave it optional to a pupil whether or not he 
will avail himself of the privilege. The results have 
shown that while at first only a part of the children 
participate, in the end almost every one takes part. 
The school bath wins favor quicker when the children 
are encouraged, treated with consideration, and the 
rooms are comfortable. The practice of furnishing 
school children with free tickets for public baths falls 
far short of having the baths in the school. On the 
other hand, it is entirely feasible to permit the general 
public also to use the school baths. A separate en- 
trance may be provided for this purpose, as has been 
done in some places. Such an arrangement might be 



THE SCHOOLHOUSE 65 

particularly helpful in rural communities, where 
children who have enjoyed the school bath could thus 
continue its use after graduation. 

Swimming Pools. — Swimming pools and instruction 
in swimming are beginning slowly to be introduced 
into the public schools. Naturally this innovation 
depends upon the opportunities in this direction which 
the school possesses. It is encouraging to know, for 
instance, that from April 1, 1908 to October 1, 1909, 
31,333 London school children were taught to swim in 
60 of the public baths of that city. 

School instruction in swimming can readily be im- 
parted to large numbers of children by means of 
apparatus and exercises before the pupils enter the 
water, at least six such instruction periods being re- 
quired. After these exercises the fourteen or fifteen 
year old children can ])e admitted to the tank, where 
they are held by apparatus, a whole row hanging on 
a cable stretched across the basin. Having then 
acquired skill in the arm and leg movements in 
the water itself, after two or three lessons they are 
permitted to swim freely with belts or other support- 
ers, and under the supervision of a teacher. The '' dry 
swimming" is practised in the afternoon gymnasium 
periods; later on these periods are used for swimming 
practice in the water. This practice has been in- 
troduced in different cities. In adcUtion, in Germany, 
Austria and Switzerland there is school instruction in 
swimming under various other procedures, but the 
above-mentioned system will prove most valuable in 
teaching large numbers of children to swim. The 
rapid loss of body heat in the water, the increased 



66 SCHOOL HYGIENE 

respiration necessary for swimming in consequence of 
the pressure of water, and the possibihties of ear diffi- 
culties, make a medical examination of the pupil a 
necessity. 

Rooms for Domestic Science. — Other marks of 
modern development in the school are classes in do- 
mestic science and provisions for school feeding. In- 
struction in cooking, especially for older girls in the 
higher classes, occupies a prominent place in Scandi- 
navian schools. The practice is also spreading in 
Germany, where it is being promulgated by the efforts 
of Auguste Forster, Kalle, Kamp and others. In 
England such instruction in the public schools is pre- 
scribed by law and the state contributes to the cost at 
the rate of four shillings per scholar. In London the 
dishes thus prepared are sold to the children, thereby 
making the establishment self-sustaining. These 
cooking classes date as far back as 1878. In the same 
city, in 1890 the first '^washing centers" were estab- 
lished for school instruction in laundry work. In 1903 
there were 142 such centers in operation. At the 
present time, the cooking, washing and other house- 
hold activities are taught in small, easily accessible 
housecraft schools. Not every school in London has 
its own establishment, but a number of schools have 
access to a common center, convenient to all. 

School Feeding. — School feeding may be instituted 
either for the benefit of children who live too far from 
the school to go home for the noonday meal, or it 
may be for the purpose of giving good food to very 
poor or neglected children. The arrangement made 
in the public schools of Paris is excellent. There the 



THE SCHOOLHOUSE 67 

children may have their luncheon (dejeuner) in the 
schoolhouse by presenting tickets, some of which have 
been paid for and some of which have been given gra- 
tuitously, and no one knows which child has paid and 
which has received charity. In some German cities also, 
in Munich for instance, provision is made quite as a 
matter of eburse for feeding the poorer children of the 
public schools. More than one-third of all German 
cities offer food in some way or another. The expense 
in such cases is usually defrayed by private benefac- 
tions, though there is a more or less definite tendency, 
especially in Switzerland, to regard it as an obligation 
of the state to supply sufficient and good food to the 
child who is badly nourished at home. The aim in 
many cities is to give aid where needed, an(% to ask 
for payment where the parents are able to afford 
it. 

Toilets. — Both with respect to location and usage, 
the toilets of the school demand special hygienic 
consideration, as under adverse conditions they may 
easily prove a menace to health. Experience in 
school life, as well as a mass of statistical evidence, 
points out the need for improvement in this direction. 
In the first place, the school periods must be so ar- 
ranged as to give the children recesses during which 
they may attend to their necessities, and in addition 
the children should be permitted to leave the class- 
room when necessary. Retention may often lead to 
harmful results, to maiming or permanent weakening 
of the bladder, to costiveness, as well as to sexual 
irregularities. In pubescent girls the increased flow 
of blood to the pelvic organs at certain times, accel- 



68 



SCHOOL HYGIENE 



erated by long sitting, creates a necessity for more 
frequent urination. 

Unclean toilets may be a menace to the air of the 
schoolroom; unclean fluids from the toilets may con- 
taminate the walls and even the drinking water. On 
the other hand, if the toilets are placed at some dis- 
tance from the building, the children are in danger of 
taking cold when going to them in winter, especially 




Fig. 33. — Location of toilets with entrances from the corridors. 
B = Boys, G = Girls. 

the older girls at certain periods and delicate younger 

children, and there is always the possibility that 

children will not take the trouble to go to such toilets 

when necessary. 

The dangers which spring from toilet gases in the 

rooms, and waste fluids penetrating the walls, have 

led to the demand that toilets shall be located outside 



THE SCHOOLHOUSE 69 

of the school building, which vastly simplifies the 
schoolhouse plan, though if we stop to reflect we must 
admit that no architect would think of placing in the 
yard the toilets of a two or three-storied dwelling 
house. Why then, should this location be absolutely 
necessary for the school? The fact is, that with the 
use of the modern improvements it is not necessary 
for the school, as has been shown long ago in Austria. 
There can be no objection to toilets on every floor 
of the schoolhouse, if they 
are located in an annex. 
Fig. 33 shows toilet rooms 
divided off from the corridor, 
one section for girls (G) and 
one for boys (B) with en- 
trances from separate corri- 
dors. 

With a central water „ „ .,. , ^^ , 
, - m • . Fig. 34. — Siphon closet. 

supply oi sumcient pressure 

as found in large schools, detached siphon closets 
(Fig. 34) may be installed. These insure absence of 
odors, because not only is the waste immediately 
removed, but the standing water in the bowl (W) 
prevents the rise of sewer gases. At the commence- 
ment of the long vacation it is well to pour a little 
oil into the basin to prevent evaporation of the 
water. Where there are no sewers, the prevention of 
odors can also be accomplished by scattering saw dust 
into the pit after each use. But the whole mat- 
ter of chsposal of waste is so bound up with the 
conditions of the public removal of refuse in the locality 
in question that it is impossible to go into technical 




70 



SCHOOL HYGIENE 



matters here. The toilet rooms should be light, the 
walls of a glossy surface, so that they cannot be readily 
marked. The best way to accomplish this, though 
expensive, is to have the walls covered with glazed 
white tile, which is durable and can be washed. 
Where this is not possible, the walls might be plastered, 
the plaster laid in vertical grooves, after which the 



o 




Fig. 35. — A closet for country schools, used in Maine. 

whole surface is painted in a light color, care being 
taken to use no lead. 

Where pits are the only receptacles for waste, it 
is necessary to have these quite apart from the 
building and constructed in such a way that the 
leakage of the waste is avoided. For building the 
foundation, hard bricks laid in cement or asphalt are 
to be recommended, and the waste pipe must be 
constructed absolutely water-tight. Above all, the 
use of cesspools, which lead the waste fluid away 
by filtering through the ground, should be absolutely 



J 



THE SCHOOLHOUSE 71 

prohibited. They are entirely unhygienic, for they 
are likely to contaminate the water supply. 

For little country places the practice proposed by 
the board of health in the state of Maine (United 
States) is to be recommended. Under the seat of the 
closet stands a water-tight bucket (Fig. 35), or 
one of cast iron, and in a box within the closet is a 
supply of earth, sawdust or ashes, of which the children 
are to throw a shovelful into the bucket after each use. 
One wagon load of this material is found to be sufficient 
for a school j^ear. Daily, after the close of scliool, 
the contents of the bucket are removed through a door 
in the rear and are thrown on a compost heap or turned 
into fertilizer and covered with earth. When one 
sees the manure heaps of the countryside to wfcch are 
added th(^ waste deposits of the closets, it is not difficult 
to imagine that infection may spread by means of the 
domestic animals. This emphasizes the need for the 
school to exert its educating influence also in this 
direction as well as in another direction — that of 
ventilation. Many persons in the country never 
open, their windows, with the result, as proved by 
statistics, that in rural districts preventable diseases 
are more frequent, comparatively speaking, than 
among urban populations. It is, of course, true that 
country children are more hardened than city children. 
Hence, it is permissible in country schools to have the 
closets out-of-doors, though it is desira])le to construct 
a covered passageway leading out to the facilities. 

Urinals. — It is not possible, with such simple 
arrangements, to keep urinals free from odors. For 
this reason, it is desirable not to install them, but to 



72 SCHOOL HYGIENE 

have the children use only the above-mentioned closet. 
For special places the oil urinal* is an ideal ar- 
rangement. The walls are covered with a prepara- 
tion to which urine does not cling and the oil in the 
siphon which collects the urine, covers it and renders 
it practically odorless. These oil urinals, which are 
being widely used, can be kept odorless with very 
little effort, which can hardly be the case when only 
water is used. 

Bodily needs should be attended to during the re- 
cess periods; consequently the closets should be 
near the recreation rooms and the playground. 
Ordinarily one closet is planned for one class, but 
with classes of fifty or more additional facilities are 
needed. When the toilets are under supervision or 
the children have the impression that it is so, it is not 
necessary to limit particular ones to certain classes. 
Above all, the supervisors must see to it that the closets 
are not made untidy. Cleanliness can be best en- 
sured if the children themselves are urged to report 
immediately any toilet found in an untidy condition. 
It is very convenient to have the lavatories connected 
with the toilets, but with regard to washing accom- 
modation our schools leave much to be desired. 

School and Dwelling. — The combined school and 
dwelling house needs brief discussion. It is a plan 
not to be rejected because it is often the only feasible 
one. In large cities, the ground is so expensive that a 
separate house for the principal and teachers is pro- 
hibitive. And again a school of this kind may be 
used for such a variety of educational purposes as to 

*Made by W. Beetz in Vienna. 



THE SCHOOLHOUSE 73 

make the residence of tlie director within the building 
very desirable, and the work of cleaning and heating is 
also facilitated if the janitor is lodged in the house. 
In country schools where the children come from a 
great distance, it is of advantage to them to be able 
to get a warm meal cooked by some one connected with 
the school, who may also in other ways show her 
motherliness. Of course, care should be taken that 
such accommodation of the teacher and his family in 
the schoolhouse shall not prove a drawback to the 
school, which might be the case if i)ationts with con- 
tagious diseases are kept within the schoolhouse, and 
odors from the kitchen or from impure water in the laun- 
dry, etc. are allowed to penetrate to the classrooms. In 
the interests of the director, his rooms should include at 
least one that is sunny and away from the noise of 
the children. The director is entitled to accommoda- 
tions which will afford him and his family a com- 
modious home; hence none of the rooms should be 
located in the ])asement nor should there be less than 
three living rooms. 

The use of the schoolrooms for other than school 
purposes may prove hygienically undesira})le; social 
gatherings may litter up the floor, and contagion 
from sickness may enter. It should be the duty of 
the city or town authorities to see that the health of 
the children is not endangered. 

Cleaning. — The cleaning of the schoolhouse has 
already been mentioned and it must be admitted that 
in this direction much progress needs to be made. 
In this respect, as with regard to lighting, ventilation, 
seating, toilets, etc., the school differs by virtue of its 



74 SCHOOL HYGIENE 

intensified use from other dwellings and demands 
special means to keep it sanitary. Improvement will 
come when the general public has been hygienically 
educated to realize special menaces to health, as well as 
conditions necessary to safety and comfort. Cleaning 
operations which will stir up dust should never fall 
upon the pupils. In this matter of cleaning, Denmark 
has made a distinct advance by introducing into the 
law of 1905 for the fight against tuberculosis a .clause 
covering this point. Another exemplary provision is 
contained in an edict issued by the city of Copen- 
hagen in 1908. It is practicable in large schools to 
contract for the cleaning and heating, as is done in 
some cities of Germany. Where possible, a vacuum 
cleaner should be installed. 

Fire Regulations. — Large school fires and terrible 
panics among the children have taught the stern 
lesson that the construction of the school building 
and the order maintained during an emergency must 
be such as to avert like occurrences in the future. 
For this reason the fire drill at least ojice a month 
should be a matter of school routine. All large schools 
should be equipped with fire escapes, as is the case in 
American cities. 



II 

THE HYGIENE OF INSTRUCTION 

1. General Consideration 

Fatigue. — Prolonged labor of any kind leads to 
fatigue. Fatigue is regarded as due to the accumula- 
lation in an organism of certain products of met- 
abolism, the presence of which tends to diminish energy. 
It must not be supposed, however, that the su})jcctive 
expression of fatigue, i.e., the feeling of bciii|5 tired, 
is an exact measure of the degree of fatigue, though 
it is usually an important indication. Following 
fatigue, rest, nourishment, and fresh air bring recovery 
from the tired state. But to aid the healthy develop- 
ment of the child more is needed than mere alternation 
of brain work and mental rest. The muscles of the 
child also require exercise for their growth; this ex- 
ercise likewise produces fatigue and in its turn demands 
periods of rest. Fatigue is essentially a general con- 
dition; the products of dissolution which accumulate 
through brain work produce a diminished capacity 
of the muscles as well as the nerve cells, and vice versa. 
Weichardt in Erlangen (Germany) who has succeeded 
in injecting into an unwearied animal a substance 
called kenotoxin extracted by him from the muscles 
of a tired animal, has observed in the former all the 
characteristic signs of fatigue. To overcome this 

75 



76 SCHOOL HYGIENE 

experimental^ produced fatigue, he then used an 
antibody, or reactive agent, which he injected into the 
animal. These facts are not cited as urging that a like 
procedure be undertaken with school children, though 
Lorenz in Berlin has proved that the spraying of an 
anti-kenotoxin in the air of the schoolroom diminished 
fatigue in the pupils. But such means of recuperation 
are not to be advocated, for fatigue signifies need of 
rest and if fatigue were artifically prevented new work 
would commence at the undue expense of the reserve 
power of the child. This is especially dangerous for 
children because they not only need to restore used 
material but to accumulate new material for growth. 

These are problems which still await definite solu- 
tion, though this much is certain — fatigue should 
never be permitted to reach the stage of exhaustion, 
that is, it should not be carried so far that the devel- 
opment of the child is hampered. The rule should 
be that complete recovery must follow a day's work 
before the next day's tasks are begun. 

Increases in height and weight are good indications of 
proper development. If a child who has healthy 
parents and to all appearances a hygienic environ- 
ment, Sftill shows signs of physical backwardness, this 
lack of development must be regarded as an un- 
favorable sign. Constant watchfulness of the de- 
velopment and the hygienic conditions of school 
children is a matter of public interest. In this con- 
nection it might be particularly valuable if we could 
know how near at any given moment the state of 
fatigue is to its physiological limit, or whether it has 
already reached the pathological condition. Our 



THE HYGIENE OF INSTIIUCTIOX 77 

knowledge on this point is meager, which is not to be 
wondered at when we consider that research in this 
field has been undertaken only during the past few 
years. 

A full discussioti of the subject of fatigue would far 
exceed the limits of this book, but in order to give the 
reader an idea of the means taken to determine the 
presence of fatigue, a few methods will be presented. 
The psychological metho<^ls require the child to com- 
pute figures, to keep numbers or words in his memory, 
to recall previous happenings and to complete the sense 
of broken passages. 

Another way is to estimate the fatigue elements 
resulting from either mental or physical labor by 
testing muscle capacity with the ergograph, an mstru- 
ment designed by Mosso of Turin. The test nuide is 
of the amount of muscular work which can be per- 
formed by the middle finger, the subject lifting a 
weight rhythmically as many times as he is able. The 
weight hangs on a string which runs over a roller. 
The heights to which the weight is raised and the 
rapidity with which one stroke follows another are 
indicated 1t>' the instrument, and the sum of the results 
in the given time, with a given weight, constitutes 
the work, which is recorded in meter-kilograms. No 
matter what the cause of fatigue, the tired individual 
is able to perform only a fraction of the work that he 
is able to do in a rested condition. 

Another plan, that of Weichardt, is to estimate the 
degree of fatigue by dumbbell work and foot move- 
ments; or, according to Schuyten of Antwerp, by a 
dynamometer which registers the pressure power of 



78 SCHOOL HYGIENE 

the hands. The ami of the phj^siological methods 
is to show the decreased power of the sense organs 
under fatigue. If the finger tip of a normal individual 
is touched with the two points of a compass, he will 
be conscious of two separate sensations, even when 
the points are very close together; but in order to get 
two separate impressions when the compass is placed 
on the upper arm, the two points must be placed 
relatively far apart. 'It has been found by Griesbach 
of Mlilhausen (Germany) that under fatigue the points 
of the compass on the finger tip must be widened to 
produce two sensations, and the degree of fatigue is 
indicated by the distance between the points. This 
is the sesthesiometric method. 

While the results achieved by these methods indi- 
cate the general usefulness of such procedures, some 
very decided objections can be raised and the results 
of one method do not always corroborate those of 
another. But nevertheless we must not abandon 
the hope of arriving at a method which shall be 
free from objections. As a matter of fact, the re- 
searches made in different laboratories with different 
methods have already shown a general tendency in 
one direction. 

Constitution. — That individuals differ in natural 
aptitude or constitutional tendencies as well as in de- 
velopment is a universal truth. The further fact, 
however, is not so well known that, as a rule, the 
children better equipped physically, that is the heavier 
and larger children, make better school progress on 
the average than the weaker ones, a finding which 
gives added meaning to the phrase, "a sound mind 



THE HYGIENE OF INSTRUCTION 79 

in a sound body." This truth was wholly disregarded 
until Russian investigators emphasized its importance, 
and the extensive investigations of Porter in Boston, 
F. A. Schmidt and Lessenich of Bonn (Germany) 
corroborated the statement, which was further proved 
by the work of many other investigators, among 
them Graupner of Dresden, Quirsfeld of Prague, Rietz 
of Berlin and S. Rosenfeld of Vienna. 

Defective Children. — The very great differences 
existing in mental capacity are better detected in the 
elementary, than in the high school, where a 
more or less selective process has operated. Because 
of a realization of this wide difference of aptitude 
among children much is heard about subnorm^ and 
backward children. From the standpoint of school 
hygiene such discussions are to be warmly welcomed. 
Among the subnormal the first to receive consideration 
in the school are the mentally defective, then cripples 
and epileptics, and moral defectives. The blind and 
the deaf have always received special care and need 
hardly be considered in connection with the public 
school. Finally we have children who are retarded 
because of chronic diseases such as tuberculosis and 
trachoma, as well as constitutionally weak children 
and those who are nearsighted in a high degree. 
Public interest is aiming to provide for all these the 
advantages of education, of which they would other- 
wise be deprived to a greater or less extent. 

As a rule, mentally retarded children fall behind the 
normal in weight, as Schmid-Monnard in Halle 
(Germany) has shown. Malnutrition and sickness 
likewise play a large role among the backward. More- 



80 SCHOOL HYGIENE 

over, because of their inability to keep pace with 
other, normal children, such pupils are at a disad- 
vantage psychically. It frequently happens that the 
teacher for a time misjudges such children, regarding 
them as lacking in ambition. That there are intelli- 
gent children among the defectives who are unfit for 
the public schools is instanced by the word- blind. 

Special Classes. — The normal, subnormal and ab- 
normal are not separated by wide gulfs; there are 
gradual stages of transition from one to the other 
groups. The diagnosis of defectiveness is not always 
easy to make and hence special methods for testing 
intelligence have been designed. By placing the 
backward pupils in a special class final decision 
can be deferred for some time, though, unfortunately, 
parents frequently object to this procedure, notwith- 
standing that it is the wisest course for the child, who 
is thus taught by a specially trained teacher, in 
company with only a small number of companions, 
perhaps not more than twelve. In the special classes, 
the pupils can have a maximum amount of recreation, 
medical attention, etc., that is, they are especially 
cared for also from the standpoint of their physical 
health. The carefully kept records of these classes are 
frequently of value, as in examination for military 
service, or in questions of liability in a court of justice. 
Moreover, the practical training received in these 
special classes is of great advantage to those who at the 
end of school must earn their living. It has been 
computed that from 1 to 2 percent of the school 
children in different countries are defective — a number 
sufficiently large to demand special study and atten- 



THE HYGIENE OF INSTRUCTION 81 

tion. In the city of Mannheim (Germany), Sickinger 
has made an attempt to systematize the care of the 
various types of subnormal children. 

School Age. — Most children are ready for school 
when they have passed their sixth l^irthday, that is, 
they are then sufficiently developed to undertake school 
work. This age has been generally chosen because 
while up to the seventh year of life the brain grows 
rapidly, after this period, growth is at a much less 
rapid rate. That organ is therefore cjuite well 
developed when the child enters school, although not 
yet adaj^tcMl for abstract thinking. The worst feature 
at the l)eginning of school life is this, that the transition 
from a state of freedom to confinement is too pro- 
nounced; the hours of instruction are to<T long 
and the recesses too short. It is demanded of the 
child whose interest is naturally fickle at this age, that 
he shall seriously concern himself with certain things, 
and he must, in addition, sit absolutely still. The 
fact that we are here concerned with a real problem is 
demonstrated ])y the investigations of Schmid- 
Monnard in Halle (Germany) who found that among 
children of all ages, from birth to the fourteenth year, 
those showing the least increase in body weight be- 
long(Hl to the seven-year group, i.e., those in the first 
year of school life, while those chiklren who for some 
reason spent this year out of school showed a decidedly 
greater increase in height, as well as weight.^ In the 
case of weak children, the effect was evident even 
in the second school year. Hertel of Copenhagen, 
basing his conclusions on observation made upon 



82 SCHOOL HYGIENE 

thousands of children, found that there is an increase 
of illness at school entrance. 

Co-education. — One of the most important edu- 
cational problems of the present day is the co-educa- 
tion of boys and girls. The subject can be considered 
here only from the point of view of school hygiene. 
The question reaches its most critical stage with 
regard to the secondary school, for in the elementary 
school the requirements are less severe and moreover 
there is separation of the sexes so far as gymnasium 
work is concerned, because of the weaker frame and 
musculature of girls. But, as we shall see later, even 
in the elementary school the subject of boys and 
girls in one and the same school deserves further 
consideration. 

The origin of co-education in Europe lies in the 
tendency to increase the earning capacity of woman. 
Co-education is the consequence of the attempt to 
equalize the position of the sexes. In addition, certain 
practical questions are often involved, for instance, a 
community ma}^ not be able to afford a separate high 
school or college for girls, and again the number of 
girls desiring this education may be so very small that 
accommodation might easily be arranged at a boys' 
school. In view of the more taxing curriculum 
demanded in the secondary as compared with the 
elementary school, the highly diverse physiological 
differences of the sexes demand paramount con- 
sideration. As the subject is large, only a few 
facts of experience and those gathered from sta- 
tistics will be given. Of the greatest importance 
is the difference of development at puberty. The 



THE HYGIENE OF INSTRUCTION 83 



period of pubescence in boys is longer than in 
girls; but it more deeply affects the girl, as it 
is connected with greater changes in the body, 
and a successful transition is of the greatest 
significance to the woman of the future. The first 
appearance of menstruation, in the temperate zones 
between the ages of fourteen and sixteen years, is 
only the final manifestation of a whole chain of 
developmental processes. The determining factor in 
this consideration must be the comparative vitality 
of the two sexes, as it can be learned from the study of 
a rich array of statistical evidence concerning sickness 
nnd mortality. A few such facts are shown below. 

Table I. A Comparison of Boys .vnd Ciiils in Secondary 
Schools with Respect to Illness* ^ 



Name of 
investigator 


Country 
(or city) 


Boys 


Girls 


Number 
examined 


Percent 
sick 


Number 
exaininod 


Percent 
sick 


Hertel 

Danish 
Commission 

Key 

Norwegian 
Commission 


1 

Copenhagen 

Denmark 
Sweden 

Norway 


1,900 

16,789 
11,210 

830 


31.1 

29.0 
34.4 

21.9 


664 

11,330 
3,072 

SCO 


39.4 

41.0 
61.7 

36.7 



* The l)oys in these cases are from puhhc Latin and modern 
schools, the girls from similar private schools, with the exception 
of those examined by the Danish Commission, where both boys 
and Kirls were students of the public schools. The Latin and 
modern schools are mostly day schools supported by the state, the 
parents paying a moderate tax, or in case of poverty, nothing. 
(In reading the book it should be borne in mind that the educa- 
tional systems of Germany and Scandinavia differ from the 
American. The "higher schools" of Europe do not correspond to 
our high schools*, they do not follow the elementary schools, but 
rather overlap some of the work of the lower schools. Translators.) 



84 SCHOOL HYGIENE 

The above statistics have been selected because they 
include large numbers and the pupils are distributed 
over a wide geographical field. 

Certain pathological manifestations, as anaemia, 
chlorosis, and recuiTing headaches, are particularly 
frequent among girls, who also are more prone to 
develop irregularities of the spine, all of which would 
seem to point to a lower capacity for resistance. These 
statements are substantiated by the findings of the 
pathological anatomist Key of Stockholm, whose 
investigation has already been mentioned in the 
preceding table. 

Table II. Key's Findings of Chlorosis and Headache 

I Xo. examined Chlorosis i Habitual headache 



Boys I 11,210 I 12.7% 

Girls ' 3,219- i 35.5% 



13.5% 
36.1% 



With reference to anemia in girls, Tjaden in 
Giessen found the following: 

Table III. Tjaden's Findings of Anemia 

Autumn examination Spring examination 

Boys 5= 0.7% 18= 2.1% 

Girls 121 = 13.6% 157 = 16.0% 

Eulenberg in Berlin found among 300 children 
afflicted with spinal curvature that 13 percent were 
boys and 87 percent girls. 

The findings of Lindholm in Helsingfors (Finland) 
the school physician of a higher co-educational 
school, are: 



THE HYGIENE OF INSTRUCTION 



85 



Table IV. Lindholm's Findings of Anemia and Headache 



Anemia and general 
weakness 



Habitual headache 



Boys. 
Girls 



22% 
38% 



10% 
31% 



A number of observers point to the thirteenth year 
as the most critical for girls, that is, during this year 
there is more illness than in others. If we consider the 
usually accepted standard of education, that for the 
boy, this year as a rule comes when the girl is already 
in the higher school. In Helsingfors where physical 
training is compulsory and excuses are granted only 
on the statement of a physician, Palmberg has found 
that in the elementary schools among 1,684 ^pys and 
girls none were excused, while in the higher schools he 
found the following: 

Table V. Excuses from Physical Training Granted to 
Pupils of Higher Schools in Helsingfors 





Higher public schools i Higher private schools 




Total 


Percent Total Percent 
excused excused 


Bovs 


1,152 
1,306 


1.30 
3.70 


1,275 
973 


3.06 


Girls 


11.63 







The reason for excuse of 51 percent of the boys and 
35 percent of the girls was functional disturbance of 
various kinds, while 49 percent of the boys and 65 
percent of the girls were excused ))ecause of general 
debility. Lindholm's results in eight small towns in 
Finland show similar ratios. 

This array of statistical data would seem to show 
that from the viewpoint of hygiene the co-educative 



86 SCHOOL HYGIENE 

system in high schools is detrimental to the health of 
girls. The argument of lesser mental ability in the 
case of girls has been proved. wholly futile: indeed, 
the results show that girls succeed rather better in their 
studies than boys. Hygienically important is the fact 
of the greater suggestibility in the case of the girl, as is 
proved by the spread of psychic epidemics, for instance, 
muscular twitching in girls' schools rather than in 
boys'. For this reason also, one might almost say 
unfortunately, girls are more readily stimulated to 
increased endeavor, which in view of the great de- 
mands made in the high school and the unquestionably 
smaller resistance force of the girl, can not be con- 
sidered as advantageous to health. 

It is difficult, in view of the above mentioned and 
absolutely unbiased facts, to meet the demand of the 
present time for the higher education of girls, a demand 
which is based not alone upon ideal considerations, 
but also upon necessity. There are other grounds 
as well on which co-education has been condemned, 
one being the moral question, though we do not consider 
these arguments conclusive. If there are separate 
wardrobes and toilets, and if the gymnastic exercises are 
not given in common, there is little to be feared from 
competition in the schoolroom and the meeting of 
boys and girls in supervised playgrounds, even though 
occasional irregularities, often springing from natural 
impulses, have been reported. When it comes to 
that, objectionable practices are also found in separate 
schools and it is doubtful whether co-education in- 
creases them. Especially in small towns where the 
young people meet outside of school it is true that 



THE HYGIENE OF INSTRUCTION 87 

public opinion acts as a control; this, of course, is 
absent in large cities. 

The real hygienic difficulty of co-education is 
presented by the curriculum. In accordance with the 
incidence of sickness found among girls, the curricu- 
lum beginning with the tenth year of life should be 
better arranged to meet the requirements of health. 
Guided by the investigations of Key, we must consider 
the period of pubescence as one of lessened resistance, 
and the years of development into womanhood as 
requiring the greatest care, for it may oth(^rwise happen 
that during this critical period pathological con- 
ditions will develop which are carried throughout life. 
For this reason, the curriculum of the higher school 
must be differently planned, there must be less sitting 
still and more exercises in the open air. One solution 
would be to have a lower standard of work for girls at 
a certain age in those studies which are most taxing, 
and to plan the curriculum with special reference to 
the endurance of each year. The free hours should be 
used for bodily exercise. This means, of course, that 
in a co-educative system the girls can not compete 
in the same examinations with the boys. That, how- 
ever, should not prove an insurmountable difficulty, 
for those girls who are not seeking the education as a step 
to self-support would no doubt be satisfied with a re- 
stricted curriculum, while to the remainder, opportu- 
nity might later be afforded, when they have attained 
maturity, to complete their studies, so as to enable 
them to take the full examinations. If girls would be 
content to add an additional year or a year and a half 
to their school course, there would be no disproportion 



88 SCHOOL HYGIENE 

in the end in countries where young men are obliged 
to spend some years in mihtary service. 

In Europe co-education in the high school has been 
developed to its fullest extent only in Scandinavia and 
Finland, where it is being attacked by present-day 
hygienists. It is spreading in Switzerland and in 
the German Empire (Baden, Wiirttemberg, Saxony) 
and is beginning also in Austria. Conditions in the 
United States can not be compared as a whole with 
those of continental Europe because such varied 
practices exist in different states. Co-educational 
colleges have been established, especially in the west 
and south of the United States. They differ from the 
European plan in that students may choose their 
subjects in part, and the healthful recreation afforded 
by the school is open to both sexes. It is a noteworthy 
fact that at the passage of the new rules for girls' 
high schools the school board of Prussia has taken 
account of the lessened resistance of girls and has 
taken action accordingly. In view of the profound 
significance that the higher education of girls has for 
the individual, the family, and the state, a definite 
regulation by a provision such as the Saxony law of 
1910 is heartily to be recommended. At all events, 
care should be taken in every co-educative high 
school to prepare a different curriculum for girls than 
for boys. This conclusion seems unavoidable in the 
light of the facts that have been presented. 

2. Number of Pupils and Curriculum 

Number of Pupils. — The meeting together of many 
individuals in one room for instruction is the most 



I 



THE HYGIENE OF INSTIIUCTION 89 

characteristic feature of the school. We have 
already discussed how the usefulness of this room is 
affected by the fact that the daylight diminishes in 
proportion to the width of the room, and how the 
size of the classroom is controlled by the limits of 
hearing and seeing. These limitations affect also 
the number of children who can constitute a class. 
It has also ])een mentioned that the air of a classroom 
becomes rapidly unhygienic, even when 4 cubic meters 
of air are allowed for each pupil. At this rate, a room 
measuring 9 by (3 by 4 motors can accommodate about 
fifty pupils, though the total ^uml)or of cubic feet 
(216) can not be considered as being wholly air space, 
for the furniture and the children themselves take 
up room. The number fifty has been deftrmined 
on the grounds of light, air, etc. But experience 
teaches furthermore that contagious diseases and moral 
delinquencies make headway easier in large classes 
than in small; and the teacher of a large class finds it 
difficult to accustom many of the children to correct 
posture. That the instruction itself must suffer is ab- 
solutely clear. This fact is of hygienic importance in 
so far as it concerns certain unfavorable psychic 
effects upon some children, who need individual 
attention which they cannot receive in an overcrowded 
class. Lastly, an overcrowded class does not afford 
healthful work for the instructor. 

The problem of the number of pupils to a class is not 
to be solved purely from a hygienic standpoint; often 
it must be a question of finances. That it can be 
successfully solved, however, is proved by a number of 
instances. According to the law of Norway passed in 



90 SCHOOL HYGIENE 

1889, the maximum number of children in country 
classes is 35; under pressing economic conditions it 
may be 45; in cities the numbers are 45 and 50 re- 
spectively. According to the published reports of 
average classroom attendance, we find that for in- 
stance during April 1900, the average number of school 
children per class in Christiania was 33.1; in Dron- 
theim at the end of September, 1901, 31; in Bergen, 
33.9; in Stockholm, in 1893, 36 — all well within the 
lawful maximum. In Denmark, the law of 1899 
limits cities to classes numbering 35 and country 
schools to 37, and it must be mentioned that addi- 
tional funds were also appropriated to meet the need 
created by this law. In London the number of 
children under one instructor decreased during the 
period from 1873 to 1903 from 80.5 to 41.9 pupils. 
All the above-stated numbers apply to public schools. 
In Alsace-Lorraine the law of 1883 stipulates that for 
the three lowest grades of the higher schools the 
number shall not be more than 40; for all others the 
maximum is 30. The edict of Prussia, issued in 1894, 
specifies 40 as the largest number allowed per class in 
secondary schools for girls. Where such limits have 
not been set, it would be of material help if at least for 
the more difficult courses the overcrowded classes of 
high schools were divided into two sections. 

In speaking of classes of fifty it was not intended 
to indicate this number as a hygienic ideal. It is 
mentioned as being hygienic only by contrast with 
the overcrowded condition of public and high schools 
everywhere, and because it promises to be a possible 
ideal. Overcrowding is an evil which has crept into 



THE HYGIENE OF INSTRUCTION 91 

the schools because formerly no hygienic limits were 
thought necessary, and so deep-rooted has it become 
that to make too radical demands at once, as for in- 
stance those of the Danish law, would defeat the ends 
in view and moan no progress. The subject of the 
number of children to a class has been discussed in 
detail because of its pedagogical and hygienic sig- 
nificance. If in this direction a public spirited com- 
munity should feci impelled to make sacrifices not 
demanded by law, it may rest assured that funds so 
invested will bear satisfying interest in the increased 
health of its children. 

School Hours. — The morning is the best time for 
school work, but one of the most important require- 
ments for the development of the child is sufficient 
sleep. The sad story of children shortening their 
hours of sleep because they nmst engage in industrial 
pursuits will not be gone into here; it is mentioned only 
to emphasize the fact that enough sleep is the absolute 
right of every child — and the recognition of the rights 
of the weak marks the culture of any civilization. 
But in addition to individual work, there may be other 
conditions in the home which will prevent early re- 
tirement; the child may live a long way from the 
school, and the home work required may be so heavy 
as to shorten the hours of sleep. Bicycling to school, 
or daily travel by train may be bad for the child if the 
way is too long and the trains are run at inconvenient 
hours. At any rate, conditions are not right when the 
child must be awakened from sleep. Every child 
should be trained to wash and dress himself properly, 
and to breakfast without haste. To begin the day 



92 SCHOOL HYGIENE 

in a state of hurry is harmful to health. In the 
case of little children, a long walk to school which in 
the winter must be begun when it is still dark, and 
morning classes with artificial light, are often detri- 
mental to health. On the other hand, early school 
hours may prove an advantage to children, for in- 
stance when the parents work in factories; the child 
may thus enjoy the comfort of a warm room in the 
schoolhouse instead of spending an uncomfortable 
hour at home. And, again, conditions in rural com- 
munities are different from those in the city — in the 
country people retire early and arise early. Hence it 
is not possible to lay down any hard and fast rule as 
to the most hygienic hours for opening school, although 
with regard to the city it is generally admitted that 
nine o'clock is the most desirable time, at any rate in 
winter. 

Carrying of Books. — The best way to carry books, 
both for boys and girls, is in a knapsack attached to 
the shoulders by broad straps. The daily carrying of 
books on one side of the body, either by a strap or in 
the hand or arm, results in many cases of lateral 
curvature of the spine, especially among girls. Fig. 
36 illustrates the different positions which the body 
assumes with different methods of carrying books. 
It is becoming increasingly customary, even in girls^ 
schools, to require the children to carry knapsacks, 
but the enforcement of their use is not all that is 
necessary; the bag must not be too heavy, or the 
consequences may be a bent back or collarbone. 
The weights which children are obliged to carry are 
sometimes very considerable in proportion to their 



■ 



THE hygienp: of instruction 



93 



body weight, the books aggregating one-fifth of the 
whole weight of the child, as has been shown by 
the investigations of Eulenberg in Berhn. Hence 
this matter has long received the attention of school 
boards. It is, of course, a fact that many children, 





Fig. 36. — Two ways of carrying books. Note the diagrammatic 

outline. 



and especially the younger ones, like to carry books 
which they do not need, and parents and teachers 
should be urged to make an occasional inspection of the 
school bag to see that it contains only what is necessary; 
but again it will often be found that children are re- 



94 SCHOOL HYGIENE 

quired to carry great piles of books. In the London 
schools it has long been the general custom to leave 
books not needed at home in the school; in some cases 
rooms provided with shelves are set aside for this 
purpose. Prussia, also, has made this provision in 
girls' schools. In Austria the law provides that 
school books must be light in weight; that is, where 
formerly a book was published for use during several 
years, it is now published separately for each year. 

Inspection for Personal Cleanliness. — It is greatly 
to be recommended that at the beginning of school, 
the teacher inspect the children from the standpoint of 
cleanliness, reprimanding those who come uncombed 
or with dirty fingernails. Unfortunately, merely 
sending a note to the parents of neglected children 
does not help materially; but much can be done if the 
school is equipped with practical washing arrange- 
ments, as in London, and the children are educated in 
cleanliness. In Vienna, Tluchor has advocated mark- 
ing for cleanliness, which is to be warmly recom- 
mended trying first of all. In some countries it is 
customary for the children to kiss the hand of the 
instructor at the beginning of school, but this is a 
mark of courtesy which should be discouraged by 
teachers, as contagious diseases may be spread in 
this way. 

Length of Instruction Periods. — In watching any 
lecture audience, it is observed that after about 
three-quarters of an hour many persons will begin to 
shift in their seats ; they will yawn, and in other ways 
demonstrate that the period of attention is too long, 
though their attendance is voluntary and no other 



THE HYGIENE OF INSTRUCTION 95 

lecture ma^^ have preceded, nor is one to follow. For 
the best pedagogical results we require of the child 
that he shall give undivided attention, and according 
to the new methods of teaching we endeavor to hold 
this attention by questions directed now to this child 
and now to that. But it is probable that the great 
mass of the pupils is unable to follow the instruction 
intensively, though there are varying degrees of in- 
attention, according to the age of the children, the 
number of years they have attended school, according 
to the topic under discussion, the personality of the 
teacher and the numl^er and character of the preceding 
lessons, etc. While as a rule the inattention of the 
pupil will act as a safety valve, as Kraepelin has said, 
protecting the child from being overtaxed, it is surely 
regrettable that the majorit}^ of the pupils in a class- 
room is compelled to receive instruction for longer than 
the profitable, receptive period. We are as yet 
ignorant as to the exact number of minutes during 
which most children are physiologically able to give 
strict attention under conditions which vary from hour 
to hour, and day to day, although a beginning in this 
direction has l^een made. But even if we possessed 
this information, a strict adherence to any such ideal 
would be impracticable in the school. The above 
illustration of the lecture audience does, however, 
seem to indicate that we can not demand of the child 
a full hour of undivided attention, much less a second 
hour. Endurance tests that have been made with 
figuring and writing from dictation seem to corroborate 
this assumption. 

But there are still other considerations which con- 



96 SCHOOL HYGIENE 

demn the long lesson. The air of the room under- 
goes unfavorable changes, a fact which becomes 
doubly significant when the children are bending 
over and are engaged in mental work; the result is a 
shallower, less forceful breathing. These facts, and 
the additional hygienic necessity of shortening the 
period of sitting still because of the need of exercise 
and relaxation from eye strain seem to make it clear 
that a classroom lesson should not exceed forty-five 
minutes in duration and should always be followed by 
a recess. In the case of beginners, even this period 
should be interrupted by a three- minute pause during 
which the children can relax and chat. Some brief 
gymnastic exercises as originated in 1904 in New 
York are to be recommended for the recess period, 
though the end would be defeated if the pause were 
devoted solely to this purpose. Mohaupt, the experi- 
enced school director of Leipa (Austria) has for a 
long time allowed these 'Halk" pauses, in the interests 
of hygiene. For beginners, half- hour instead of hour 
lessons have been instituted in the Berlin public 
schools since 1898. In the province of Hessen (Ger- 
many) the forty-five minute lesson was regulated by a 
decree in 1883, although it had already been generally 
adopted previously. Prussia has made three-quarter- 
hour classes in the high schools obligatory since 1911; 
such periods had been the custom since 1909. Keller 
in Winterthur (Switzerland) has even carried out 
forty-minute lessons. 

Recesses. — As has already been stated, recesses are 
an absolute hygienic necessity. The rapid deteriora- 
tion of the air of the classroom makes a thorough 



THE HYGIENE OF INSTRUCTION 97 

airing imperative, the eyes should have opportunity 
to glance at objects at a longer range (nearsighted- 
ness, p. 157), and there should be an opportunity 
for breathing more deeply. The circulation, also, is 
stimulated by the change from a sitting position, 
and there is a release of abdominal pressure. The 
children must also have time to attend to their 
bodily needs. Too long sitting on a warm seat may 
likewise stimulate the sex organs. 

From the preceding it is clear that not only must 
there be recesses, but such intervals must be used to 
advantage. Above all, the pupils must leave the 
classroom in a body, so that the room may be aired 
thoroughly. This, again, brings up the matter of 
recreation rooms and playgrounds and em^asizes 
their necessity. When returning to the classroom, 
after having been in the open, the children . bring 
in fresh air with them. ^It is also clear that the 
children need some exercise during the recess period, 
but it entirely defeats the object of the recess merely 
to marshall the children up and down. With reference 
to recesses, the words of the Japanese Minister of 
Education, embodied in the decree of 1894, are perti- 
nent: ''The joyous abandonment of children to their 
sports, screaming and racing, is not to be counted as 
bad behavior, nor are those who sit about entitled to 
special credit on that account." Many American 
and European teachers consider loud noises during 
recess an indication of bad discipline and yet hun- 
dreds of children at play, if they are to play 
joyously, can not of necessity be mute. It is, of 
course, not wise to devote the entire recess (twenty 



98 SCHOOL HYGIENE 

minutes) to very strenuous play, because although this 
might be beneficial to physical health, such exertion 
tends to diminish the mental energy required for the 
ensuing period (p. 120). The same can be said of 
gymnastic drills, which demand strict attention and 
strenuous muscular work, for we are not yet in a posi- 
tion to demand that active play and exercise shall 
be followed by a period of absolute rest.'* A recess 
offers a good opportunity to take a bit of food or a 
drink of pasteurized milk, served warm or cold, ac- 
cording to the season. However, the eating of sweets 
or eating just before the noon-day meal should not be 
tolerated. 

In regard to the length of the pause between two 
lessons, it is evident that one of five minutes' duration 
will not be sufficient for large schools, for in that 
time it will not be possible even to take the children 
to the recess place, much less give them time to 
satisfy the appetite which they naturally feel if the 
breakfast has been fight. In addition, time must 
be allowed for other necessities. It seems nec- 
essary, therefore, that a forty-five minute lesson 
should be followed by a recess of at least fifteen 
minutes. Naturally, part of the fifteen minutes will 
be taken up in passing to the yard and back again. 
The recess should never be forefeited on account of 
bad behavior. 

The objection might be raised that the recess period 
means a pedagogical loss, corresponding to the length 
of time devoted to recreation. On this point we desire 
to cite an investigation which serves at the same time 
to illustrate the test methods mentioned on page 77. 



THE HYGIENE OF INSTRUCTION 



99 




Fig. 37. — The efTcct of recess periods on work in arithmetic and 
dictation, according to Friedrich. 



100 SCHOOL HYGIENE 

In an investigation conducted by Friedrich as to the 
working ability of ten-year-old boys in the public 
schools with or without recesses, the following con- 
clusions, which are graphically shown in Fig. 37, 
were obtained. The tests consisted of dictation and 
arithmetic. The children were examined before 
school, after the first hour, and again after the second 
and third; also in the afternoon session, before and 
after the first hour, and after the second. Fig. 37 
shows on the lower line the time when the tests were 
made, on the left-hand side, the average percentages 
of failures in dictation (Diet.) and arithmetic (Arith.). 
The results shown in the figure were produced under 
the following conditions: 

Morning Session 

a — b = tests made before the first hour 

c — d = tests made after the first hour 

6 — f = tests made after 2 hours, with a recess of 8 minutes 

between 
e — g = tests made after 2 hours without recess 
h — i = tests made after 3 hours with a recess of fifteen 

minutes each after the 1st and 2nd hours 
h — k = tests made after 3 hours with only one recess of 

fifteen minutes after the 2nd hour 
h — 1 = tests made after 3 hours with no recess. 

Afternoon Session 

m — n = tests made before the first hour 
o — p = tests made after first hour 

r — s = tests made after 2 hours with recesses of fifteen min- 
utes after the first and second hours 
r — t = tests made after 2 hours with no recess. 

The effect of the recess is shown in the dif- 
ferences which the lines f-g, i-k, k-1, i-1, and s-t ex- 



THE HYGIENE OF INSTRUCTION 101 

press respectively for the morning and afternoon. 
The recess periods were taken from the lesson 
time. The significance of the investigation is this, it 
brings out clearly that the time lost in lessons and de- 
voted to recreation is compensated for by the in- 
creased mental productivity of the children. 

Order of Subjects. — In regard to the order of 
subjects in the curriculum, it is to be recommended 
that those subjects demanding reflection and memory, 
if possi})le should come early in the morning session, 
and such as require the best day-light, like writing, 
drawing and fine handwork should be reserved for 
the brightest part of the day, as has been prescribed 
in Austria since 1878. Two periods in which the 
pu])ils use their eyes at near range should n^t follow 
each other. It must be admitted that the depart- 
mental system of high school off"ers difficulties often 
insurmountable, in carrying out a plan of this kind. 

It would be of value if we knew exactly the fatigue 
point of the various subjects in the curriculum. 
For exani])l(», we know that it is less fatiguing to 
pui:)ils in th(^ high school to devote an hour to de- 
scribing a number of growing plants, of which they 
have specimens, than to spend the same length of time 
on a geography lesson, tracing out intricate mountain 
systems on a map, although in both cases the subject 
is nature study. Likewise, it makes a great difference 
in a foreign language class whether the task is trans- 
lation of an already familiar author, or a lesson in 
syntax, and in mathematics, whether the time be 
devoted to grasping the principle of the new ab- 
breviated method of multiplication or mechanical 



102 SCHOOL HYGIENE 

p*ractice when it is fully understood. In addition, we 
must take account of the great diversity of personality 
in the individual teacher, so far as pedagogical equip- 
ment, patience, strength, etc., are concerned. Because 
of deficiency in these qualities it may happen that the 
^^ easiest" subject may become the most difficult for 
the children. Thus it will be seen that it is not easy 
to determine the fatigue capacity of any particular 
subject. Before we can arrive at the scientific ar- 
rangement of subjects according to their difficulty for 
the pupil much intensive research work on fatigue 
must needs be done. Physical exercise also plays an 
interesting part as we shall see later. 

The One or Two-session Day. — A much discussed 
question is the une or the two-session day. It is 
not possible in the case of all schools to complete 
the curriculum during the morning, especially if 
the opening hour be late. A division of the work 
between the morning and afternoon, with a long inter- 
mission between is not objectionable on theoretical 
grounds if conditions for both sessions are equally 
favorable, as in boarding school, but in the majority 
of day schools this is not the case. The chief difficulty 
is offered by the noon- day meal, not to mention the 
other disadvantages of unfavorable light on winter 
afternoons, oppressive heat in the summer, as well 
as the fact that many children feel certain depres- 
sing psychic influences during the noon period, such 
as may be caused by impending examinations. In 
many countries, especially in Europe, it is customary 
to have the chief meal of the day at noon — a hy- 
gienically disadvantageous arrangement, which was 



THE HYGIENE OF INSTRUCTION 103 

discussed by the author twenty-five years ago,* and in 
regard to which pubhc opinion is slowly changing. 
The principal meal of the day is followed by great 
physiological exertion, i.e., the work of digestion, during 
which a greatly increased volume of blood is dis- 
tributed among the digestive organs. The adult very 
plainly feels a need for physical and mental rest, and 
if he forces himself immediately after into energetic 
work his digestion is likely to suffer. The digestive 
process is even more important for the child because 
digestion in his case is not merely a matter of metab- 
olism, a building up to replace what has been torn 
down, but also of growth. The tremerfdous physio- 
logical effect is readily realized by the teacher of the 
afternoon classes, who on his ])art is also conscious of a 
feeling of lassitude. Hence the? afternoon instruction 
will be very fatiguing and the result l)el()W what other- 
wise it might be. (Compare tests made during morn- 
ing and afternoon session, as shown by Fig. 37, p. 99). 
In addition, we frequently have unfavorable psychic 
states, as already mentioned; and the conscientious 
pupil will shorten his dinner hour to prepare for the 
afternoon, or the way back to school may be so long 
that the period of rest can be but brief. 

The work of Schmid-Monnard (Fig. 38), must be 
mentioned in this connection. An investigation was 
made by him for the i)urpose of determining the per- 
centages of illness of pupils in Halle (Germany) in 
the case of those who attended afternoon sessions 
and those who went to school only during the morning 

* This discussion also appeared sixteen years ago in the first 
edition of my " Handbuch der Schulhygiene." 



104 



SCHOOL HYGIENE 



GRADE W 



W 



VI 



V 



w 



n 



n 



14 



AGE 



7 



10 



11 



12 



13 



% ILLNESS 

40 



30 



20 
10 





./\ 



/^-•^^ 



• 




Fig. 38.— Schmid-Monnard's curves of illness among pupils 
in Halle, Germany. The dotted line shows the percentages of 
illness among those who attended both morning and afternoon 
sessions. The continuous line shows the percentages of those 
who attended only the morning session. 

hours. His material included 2100 boys who attended 
both sessions. 540 who had only the morning work; 



THE HYCilENE OF INSTRUCTION 105 

1900 girls of both sessions, and 480 who went to school 
only in the morning. The result, as expressed by the 
curves of Fig. 38, needs no comment. Steinhaus 
found similar conditions in Dortmund (Germany). 

The case stands diff(»rently where a more sensible 
division of the da}^ obtains — a hearty and later break- 
fast, later l)eginning of school, a very light meal in 
the middle of the day, which might even be eaten in 
school during the intermission, and the main meal 
at the end of the working diiy in common with all 
the family. The one-session school diiy is in use 
in a number of German cities, in Hessen, and in 
Denmark, while in Austria there is a tendency in 
that direction, es])ecially in the higher schools. An- 
other great disadvantage of the two-sessioi^ day is 
this, that the i)ui).irs time is so distributed, especially 
in tihe city, as to leave but small opjiortunity for 
physical exercise, walking, skating, swimming, etc. 
For that reason, the single session was introduced in 
the gymnasium (Latin school) of Giessen (Germany) 
as early as 188)3, wliere five short periods, with recesses 
between, make a session of four and a half hours. 
Five periods with comfortable pauses between are 
entirely feasil)le for secondary schools. The decree 
of Prussia, passed in 1911, permits even six consecutive 
forty-five-minute periods — a ])rovision which seems 
practicable in that it leaves the afternoon free, though 
it may not be desirable from other standpoints. Con- 
sidering all things, it is clear that the lengthened 
morning session of consecutive, short lesson periods, 
broken by recesses, is the lesser evil in comparison 
with the long two session school day- The curric- 



106 SCHOOL HYGIENE 

ulum as it exists in many high schools demands of 
the pupils too many hours of desk work, both in the 
school and at home. 

3. The Hygiene of Different School Subjects. 

Reading. — Reading may be harmful if the lighting 
is bad, if the seating is faulty and if the print is 
poor. Large print, such as is usually found in prim- 
ers, is necessary for the beginner, but the upper 
hmit, that is, letters measuring 14 millimeters, should 
not be exceeded, because the eye in fixing on a certain 
point at a distance as is usual in reading, can not 
readily distinguish beyond a radius of 7 millimeters. 
The transition from the larger primer print to the 
smaller normal print should be gradual. For be- 
ginners the use of a '^ reading machine" is of great 
benefit; very large letters, which are not hmited to 
the above-mentioned size, are placed on the teacher's 
desk or on the blackboard, and the children sitting 
comfortably in their seats learn with ease. Graupner 
has set 66 miUimeters as the fitting height for these 
letters. During this exercise, the children should 
not sit so that the light from the window strikes into 
tneir eyes. 

For the school books themselves Herman Cohn has 
laid down the following hygienic rules: 

The main strokes of the type in the body of the 
book should be at least 0,25 millimeters in thick- 
ness and the breadth of the letters such that not 
more than seven of these come to a centimeter. 
The lines should be no more than 10 centimeters 




THE HYGIENE OF INSTRUCTION 107 

in length and the letter "n" about 1.5 millimeters 
high with the distance between the short letters 
in two consecutive lines at least 2.5 millimeters. 
This may readily be seen in the present specimen 
from the distance between the letters "s" at the 
end of the first and second lines on this page. 
This specimen, furthermore, illustrates all the 
above mentioned requirements. (The length of 
the lines here illustrated is only 8.4 centimeters.) 

Schubert in Nurem])orp; (Clerinany) who has inatle 
a special .study of school books has orgiuated the 
conception of Druckdichtigkeit (thickness of i)rint) as 
a criterion. Cohn then invented the "line counter 
and alphabet measure"* which can readily be made at 
home b}^ cutting a square centimeter ()])ening; in a 
visiting card, measuring off on two neighl)()ring sides 
of the square a scale of millimeters and half milli- 
meters and also striking a line 0.3 millimeter thick 
to the ])rim of the card. When the little apparatus 
is laid on a i)age not more than two i)rinted Hnes should 
appear in the hole, and the thickness of the letter 
strokes should not be greater than the 0.3 millimeter 
test mark. The print should be in deep black ink, 
sharply defined; the paper not glossy, and no print 
must show through on the other side. In reading, 
the distance of the eyes from the book should l)e as 
great as the height of the child permits. Children 
are apt to lessen the distance to a point which is in- 
jurious to the eyes, not only because an erect posture 

*This " Zcilenzahler und Buchstabenmesser " can ho procured 
from F. Ticssen of Brcslau, Germany. 



108 SCHOOL HYGIENE 

demands more work of the muscles than a stooped 
position, but because the image thrown by the object 
on the retina appears larger with a shorter range. 
The result is bad posture. 

It is, of course, true that the above-mentioned re- 
quirements of Cohn are frequently disregarded, but 
that they can be met has been proved in the schools of 

mOX m^SW ^^21^ and EASILY READ 

Fig. 39. 

Basel (Switzerland) since 1886. In the maps used by 
the children in their atlases as well as the wall maps, 
only the relevant matter should be included, making 
it possible to use larger print and preventing un- 
necessary eye strain attendant upon searching for the 
required point among a number of others. Care must 
also be taken at home to see that the children do not 

Fig. 40. 

read badly printed books, in a poor Hght, in a bad 
posture, or for too long a time. 

The children of Austria, Germany, and Switzerland 
are obliged to become familiar with eight varieties of 
type, that is. Old English and Roman letters, capital 
and small letters, and printing and writing alphabets. 
Lately a tendency is becoming manifest to turn the 



THE HYGIENE OF INSTRUCTION 109 

attention onl}^ to the Roman alphabet. The greater 
ease with which the latter can be read is illustrated 
by Fig. 39, which compares ''not easily read" in Old 
English with 'easily read" in Roman type. Compare 
also the intricate curves of the Old English "B" 
(Fig. 39) with the simple lines of the same letter in 
Roman type, also the small letters of the German 
script, Fig. 40. It would be a great gain in hygiene 
if the substitution of Latin for Old English type could 
be made in Gorman books. Of course, the groat 
difficulty is that tho Old English type is regardod as 
essentially characteristic of the German language 
although so eminent an authority as Jacob Grimm 
has shown the error of this assumption.* 

Writing. — Writing is a matter even more Serious 
than reading. For children who begin to learn at 
home, the slate is to be condemned altogether, and 
pencil and paper, and eventually pen and ink should 
be substituted instead. The slate easily becomes 
scratched and gray, the writing on it is gray and 
difficult to decipher, while the fingers of the child 
often assume a cramped position because of the hard- 
ness of the writing material. The slate pencil is also 
quickly blunted. In school, where the teacher can 
not give undivided attention to each child, the dis- 
advantages increase, for the children will spit on the 
sponge or the rag with which they wipe the slate, 
and worse yet, lend these articles to their neighbors. 
At any rate, the slate should not be used beyond the 
first year of school. It has been abolished entirely 
in some cities, for instance, in Berne (Switzerland) and 

*See his Deutsches Worterbuch, Vol. I, p. Hi. 



110 SCHOOL HYGIENE 

in Klagenf urt (Austria) . On the European continent 
trials have been made at various times to invent a 
white equivalent for the slate but so far no success 
has attended these efforts. 

The surface of the writing paper should not be 
rough, shiny or transparent; the height of the note- 
book must not be over 20 centimeters, and the length 
of the lines not over 11 centimeters; the higher and 
wider the book, the easier it will be for the children 
to fall into bad positions. Badalini of Rome in his 
exhaustive researches extending over many years has 
demonstrated the fact that respiration is diminished in 
consequence of bad position. The small letters of the 
writing should not be less than 3 millimeters high; 
letters over 5 millimeters are too large in proportion 
to the finger length of small children. The children 
should also be watched at home, so that they will not 
get into the habit of writ'ng too small. 

Schubert who has made the greatest contribution to 
the hygiene of this subject has drawn up certain rules, 
substantially the following. In writing, the notebook 
must lie directly in front of the body; hence notebooks 
which are too wide must either be used in sections or 
moved gradually to the side as the writing proceeds. 
In writing from a copy, the latter should not be held 
to the side, but in front of the writer. 

An imagined line passing through the center of the 
eyes of the pupil and also the line of the shoulders 
should be horizontal with the desk edge, which means 
the upper part of the body must not be bent forward 
or sideways. The chest must not be pressed against 
the edge of the desk, but kept a few centimeters away 



THE HYGIENE OF INSTllUCTION 111 

from it. The head may be slightly bent, and the dis- 
tance of the eyes from the work will then correspond 
to the height of the child. The child should sit fully 
on the seat, the legs not crossed, with the feet placed 
firmly on the floor. The elbows should be a hand's 
breadth from the body, two-thirds of the forearm rest- 
ing on the desk, with the hand only slightly bent to- 
ward the left. The little finger and the wrist may 
touch the surface of the page. The penholder must 
be held at a distance from the pen point, with the 
upper end not pointing toward the shoulder, but to- 
ward the elbow. 

The first lessons in writing should be devoted mainly 
to acquiring the correct posture. It is better t^ begin 
with the actual writing only during the second half 
of the first school year, as suggested in the plan of 
instruction in Zurich (Switzerland). The writing 
period if it lasts an hour should be interrupted 
frequently by a change of position, especially if the 
children show fatigue. During those pauses, the 
children can receive oral instruction or they may per- 
form such easy exercises as bending the neck backward 
against the collar, stretching the body, etc. In order 
to cultivate good writing habits it is necessary to have 
comfortable desks both in the school and at home. 

Vertical or Oblique Writing. — Many investigations 
have been made into the superiority or the inferiority 
of the vertical stroke over the slant in writing and 
vice versa. Schubert especially has devoted himself 
to the problem. It is possible to discuss here only a 
few of the controversial points. There are two pos- 
sible positions of the copybook with respect to the 



112 SCHOOL HYGIENE 

pupil. It may lie either in front of the body or to the 
side, but as the latter position is generally considered 
impracticable, we need concern ourselves only with the 
front position. The book may lie on the desk straight, 
so that the lower edge is parallel with the edge of the 
desk, or it may lie o^Dliquely, with the lower edge as- 
cending to the right. The down stroke of the pen 
must in any case be toward the body. There are two 
concepts in this connection : first, the base line, that is, 
the line which joins the middle points of the two eyes; 
and the plane formed by that base line and the point 
of fixation, which constitutes the range of vision. 
Imagine a ruled copybook lying straight on the desk, 
immediately in front of the child, who attempts to 
make down strokes. Under these conditions, the 
writing will be vertical. But if the copybook page is 
laid in front of the pupil oblique to the edge of the 
desk, the down strokes will be oblique, and we have 
the slanting writing. It will be seen that the essential 
difference between the two types of penmanship 
lies in this, that in the one case the ruled line is parallel 
with the edge of the desk; in the other case it is 
oblique to the edge. The movement of the hand in 
making the down stroke remains the same in either 
case, though this is not true of further strokes as the 
writing proceeds. 

Experiments and investigations of many sorts have 
been made with reference to the movements of the 
eyes and head in relation to the down stroke as well 
as the other strokes, the distance of the eyes, the 
position of the hand and arm. It has been found 
in comparing the two types of penmanship with refer- 



ll 



THE HYGIENE OF INSTRUCTION 113 

ence to the position of the head, the direction of the 
shoulders, the distance of the eyes from the page, that 
the vertical writing gives more favorable hygienic 
results. The children writing the slant held the fore- 
arm at a great distance from the body, while the arm 
of those writing vertically was almost close to the 
body. The advantage of the latter position lies in 
this, that it is not necessary to bend the body as 
deeply as when the arm is spread, and the distance 
between the eyes and the page is greater with the 
upright position. 

Another important point is as to whether the base 
line is horizontal or oblique, the left end lower than 
the right. If the latter is the case, the head will be 
bent to the left and the left eye is nearer to the 
page than the right. The shoulders may then readily 
follow the same direction, and the result may be an 
unhygienic posture. 

A seemingly unimportant detail may often have far- 
reaching effects. It has already been mentioned that 
the penholder should not be grasped too near the 
pen point. Let us suppose, however, that it is held 
near the point; immediately the head must be bent 
to the left to observe the writing, and if the head be 
bent in this direction, the whole body will sooner or 
later fall out. of position. Unfortunately, this point 
has not been sufficiently observed in the comparative 
tests, and the investigations are for that reason not as 
convincing as they might otherwise be. 

It is evident, however, from Schubert's experiments 
that vertical writing is superior to the oblique be- 
cause it does not cause the head to be bent to the left. 



114 SCHOOL HYGIENE 

He has proved that as the writing progresses there is 
a tendency for the base Une to approach that position 
where the writing line falls into the plane of vision. 
This point is made clear by a comparison of the two 
styles of writing. If we lay a piece of ruled paper 
straight in front of us and commence writing in the 
vertical style without moving the head to the left, 
the base line is then horizontal. Let us imagine the 
plane of vision as extending through the base line 
and the point of fixation. In this case the base line 
will obliquely cross the writing line if we imagine the 
base line advancing down the plane of vision. Now 
lay the piece of paper slantwise, keeping the position 
of the head as before, and make slanting strokes. 
The base line is again horizontal but it will not coin- 
cide with the slanting line. If we imagine the base 
line advancing down as before in the plane of vision, 
it will cross obliquely at an angle corresponding to 
the degree of slant. If we sufficiently tilt the head 
and with it the base line to the left, the plane of vision 
will come into such a position that the base line ad- 
vancing down it will obliquely cross the writing line. 
Thus to write obliquely it is necessary to bend the 
head to the left to secure the right position for the 
base line, vision plane and writing line, and this 
is Schubert's argument against oblique writing. 

Moreover, the tendency of bending to the left is 
intensified when writing quickly. Vertical writing 
possesses the advantage of but one position for the 
paper — directly in front of the writer — while with 
slanting penmanship several positions are possible, 
all with a tendency of bending to the left. Grollmuss 



THE HYGIENE OF INSTRUCTION 115 



in Leipsic has devised a guide like the accompanying 
(Fig. 41), which is printed on the inside cover page of 
copybooks. The book is placed before the child so 
that the heavy line is parallel to the edge of the desk. 
Schubert, also, has a similar line painted on the 
desk. 

It is clear that vertical handwriting has excellent 
points, but notwithstanding this, it has not become 
officially popular and in places 
where it had made some prog- 
ress it has again decreased in 
popularity. 

The effect upon posture of 
the slanting penmanship is 
less noticeable in the beginner 
who writes slowly than in the 
pupil who writes rapidly. We 
can readily see why the oblique 




Fig. 41. — Guide line for 
writing runs off the pen in a Jn^Ldps^c^"^ ^^ Grollmuss 
flowing manner when we put 

a piece of paper before us and swing the arm freely 
or the hand from the wrist. Then the pen describes 
a smooth arc mounting from left to right, whose ra- 
dius is the distance between the point of the pen and 
the spot where the ball of the hand touches the desk. 
The tangent of the chord of that arc mounting up 
from left to right is the slanting writing line. For 
rapid writing such a line is easier to make than a 
straight one. For upright writing we are obliged to 
shorten the hand itself in making strokes and to 
raise the whole hand and forearm oftener as the writ- 
ing proceeds; this means more muscular work than is 



116 SCHOOL HYGIENE 

required in slanting writing. Hence the slanting pen- 
manship is better adapted for rapid writing and for 
this reason, perhaps, it is in almost general use now, 
whereas in former times upright writing was in favor, 
as is proved by old manuscripts and paintings. 

Handwork. — Sewing and fine handwork may be 
harmful if the light is poor or the position is incorrect. 
Great care must be taken to see that the pattern of 
the work, its color, fineness of finish, and the length 
of time the pupil spends over the task, shall be such 
as not to cause an inordinate strain upon the eyes 
and muscles of the body. When white embroidery, 
for instance, is done on a white ground or black on 
black, especially in artificial light, the eyes fatigue 
rapidly. The female sex is particularly prone to 
this type of fatigue called accomodation asthenopia, 
which shows its symptoms in pain over the eyes, 
headache and dizziness. Beginners in sewing, stitch- 
ing, crochet work, etc., should, therefore, use rather 
coarse materials, and later on also no work should 
be undertaken which is not discernible at a distance 
of 30 centimeters from the eyes. 

Domestic Science. — In the department of practical 
household arts it must be emphasized that the 
kitchens where the girls learn to cook, should be well 
aired, have plenty of dayhght, and the rooms for 
household work in general should be as far as possible 
free from dust. 

Manual Training. — Manual training for boys origi- 
nated in Finland. It has become widespread in all 
the north European countries, and is steadily gaining 
in favor in central Europe also. Our present point 



THE HYGIENE OF INSTRUCTION 117 

of interest in it is wholly hygienic. The work rooms 
for manual training should above all be bright and 
airy, free from dust. Sandpaper for polishing wood 
should not be used and there should be no foul odors, 
such as arise from })oiling glue. The glue must not 
be boiled in the working room but in a niche in the 




Fkj. 42. — Good (k'ft) and l)ad (right) postures at sliopwork. 
Note the main hnes t)f the body as shown by the diagrams. 

wall with an outlet to the chimney. Of special con- 
cern is the position assumed by the children during 
their work; of this Mikkelson of Copenhagen has made 
extensive studies. The aim should ])e an erect posi- 
tion, with the chest expanded, the normal curves of 
the spine maintained, and the internal organs not 
cramped. The two figures in Fig. 42, and especially 



118 SCHOOL HYGIENE 

the small diagrams to the side, illustrate good and 
bad postures. 

With respect to training for ambidexterity which 
of late has been much discussed and advocated, there 
does not appear to be much to be said in its favor; 
much time would be wasted in trying to teach the 
child to write with both hands. The hours so spent 
might be more profitably used, for instance, in out- 
door exercise. Man is not, on the whole, bilaterally 
symmetrical, as the recent studies of brain function- 
ing have proved in one direction, nor are any of the 
vertebrates strictly symmetrical. Just how far asym- 
metry is the result of one-sided activity, it would be 
difficult to demonstrate. 

Gymnastics and Play. — Gymnastic exercises and 
active play are of the greatest hygienic significance 
in the life of the child. Their physiological value 
has been set forth in an excellent way by F. A. 
Schmidt of Bonn (Germany). The Swedish gymnas- 
tics characterized by their slow movements are now 
advocated with success even in countries like Ger- 
many and Austria where the system was formerly 
looked on with disfavor, since the German Turnen 
is characterized by the opposite kind of motion, brief, 
spasmodic muscular movements. The latter has its 
fine points as well as the Swedish mode of gymnastics, 
while both systems as well as skating, swimming 
and walking are excellent exercises, especially as they 
mean time spent in the open. These sports not only 
promote increased ' breathing and heart action, but 
they also afford the eyes opportunity to enjoy long 
range vision. 



THE HYGIENE OF INSTRUCTION 119 

During the physical exercises, the children should 
wear loose-fitting garments, and should carry no 
pencils or other sharp objects from which they may 
receive injuries. Care should be taken to avoid shocks 
to the body; for instance in cold weather, violent 
exercises should not bo undertaken immediately before 
thje children leave the gymnasium. Outdoor play in 
a strong wind may not be hygienic; in any event, in 
cold weather children shoukl be cautioned to put on 
their wraps when play is over, and not to sit on the 
ground. It is undoubtedly a fact that new games are 
more fatiguing than those with which the children are 
thoroughly familiar. As a rule, active play which 
involves free, joyous running about and jumping 
makes a stronger appeal than do organized g3minastics 
without apparatus. Older children like the stimulat- 
ing competitive games which require decided effort. 
The only oljjection to some ball playing is this, that it 
demands little change of place and gives undue 
development to one arm. It is to be recommended that 
in football it should devolve upon the boys themselves 
to control and if necessary exclude their rougher 
companions. 

Big, strong fellows who make fun of weaker, timid 
companions should not be tolerated; bashful children 
must be especially invited to join in the games and 
encouraged in every way. Care must be taken in 
regard to the play or physical exercise of children who 
are convalescing from an illness. A sharp watch 
should be kept against overexertion and when a child 
begins to breathe laboriously, complains of a rapid 
heart or pain in the side, if the face becomes flushed or 



120 SCHOOL HYGIENE 

very pale, or if he suddenly becomes clumsy when 
performing simple tasks, he should be excused im- 
mediately from further exercise. Children who 
can not take part in the exercises because of a passing 
indisposition should not be stationed in a draughty 
corner to watch the gymnastics of the others, but 
should rather be sent home. 

Many children have physical defects which do not 
permit of strenuous exertion. Such disabilities as 
heart disease or a tendency to hernia may escape the 
eye of the layman, but they emphasize the need of 
a medical examination before children -are admitted 
to the gymnasium. Lastly, a point must be made 
in favor of a chfferent exercise curriculum for girls, 
because of their more delicate build and weaker 
musculature. 

It was formerly a general idea that physical exercise 
should alternate with mental labor, because physical 
exercise was interpreted to mean recreation; but 
we now understand that any severe exertion is 
work, and that recuperation from exertion of any kind 
requires rest. After hard play or after learning a new 
gymnastic exercise which requires will power and 
attention, rest is needed just as much as after scien- 
tific brain work (cf. p. 75). It is not possible to 
demonstrate here the very interesting scientific studies 
of Teljatnik in Odessa (Russia) or Oker-Blom in 
Helsingfors (Finland); but one experiment, that of 
Keller in Winterthur (Switzerland), must in justice 
be mentioned. Keller tested among others a fourteen 
year old boy with the ergograph to discover, if possible, 
the exact effect of gymnastic exercise. The test was 



THE HYGIENE OF INSTRUCTION 121 



made at two separate times, first after a lesson and a 
rest period followed by twenty minutes of gymnastic 
movements, interrupted by brief explanations. In 
this case the arms were not exercised. The boy was 
then asked to read. On another occasion the boy was 
given a twenty- minute reading lesson first, and this 
was again followed by reading. The ergograph tests 
were taken every twenty minutes. The results were 
better for the two consecutive reading periods with- 




FiG. 43. — ErgoRraph tests made l)y Keller of Wintcrthur, 
Switzerlancl, to (Ictcrinine the effect of physical exenuse on men- 
tal activity. T-L = work done after a period of gymnastic exer- 
cises followed by a reading lesson. L-L = work done after 
two consecutive reading periods. 

out opportunity for exercise or rest between than 
when there was physical exercise followed by reading. 
Fig. 43 shows the exact work done. On the lower line 
are the time periods, and the two curves represent the 
work done with the ergograph — the line T-L after 
gymnastic exercises and reading, and L-L after two 
consecutive reading periods. The ergograph results 
are read relative to the scale of 100. 

This and other experiments show graphically that 



122 SCHOOL HYGIENE 

after vigorous bodily exercise rest is needed as much as 
after mental strain ; and the experiment illustrates also 
that an hour of gymnastic work interposed between 
periods of mental activity must not be regarded as 
'^ recreation." If children are to grow up strong and 
healthy, they must have physical activity, that gained 
from vigorous play and gymnastics, but all such 
exercises demand corresponding rest. From this 
standpoint it must be admitted that the curriculum of 
many a school must be considered a failure, because it 
does not promote the physical health of the children. 

Singing. — Singing demands increased work of the 
lungs, both in inspiration and expiration. Hence it 
follows that during the singing period the air of the 
room must be pure and especially free from dust. It 
is well to use a room which has not been occupied 
during the preceding period, and this is especially 
desirable in winter, when thorough ventilation by 
help of windows and doors is difficult. Fatigue from 
singing depends upon whether the songs are familiar 
or new ones are being learned. It is well to have tha 
children stand when singing, as the internal organs have 
greater freedom in that position of the body, but long 
continued standing is very fatiguing, for which 
reason, the singing period should be interrupted by 
pauses during which the children are allowed to sit; 
these pauses might be used for explanations. The 
singing should not become a strain upon the children. 
They should start to sing softly, as the child's voice is 
not strong; shrill, forced singing should be discouraged. 
It is practicable, where children are able, to have them 
take part in two-voice singing. Those who have colds 



THE HYGIENE OF INSTRUCTION 123 

should not sing, nor those whose voices are changing. 
The dress at the neck should be loose and comfort- 
able. Singing should never be attempted when walk- 
ing against the wind, going up hill, in dusty places, 
in a raw or smoky atmosphere, nor immediately after 
severe muscular exercise. 

This section has been hmited to discussing the 
hygiene of a few selected subjects, because, as already 
indicated, reliable data on which a sound judgment 
could be based are not as yet available for all school 
subjects. 

4. Homework, Examinations, Etc. 

Homework. — Homework is too important from the 
educational standpoint to be dispensed witfr, but if 
not properly regulated it may be detrimental to the 
health of children. In the elementary schools only 
such homework should be assigned as the children 
have been prepared for in the classroom, and not 
before a proper method of studying has been learned 
in school, which includes the inculcation of good 
sitting, reading and writing habits. We are of the 
opinion that the homework generally assigned in 
elementary public schools is not excessive, although 
the regulations existing in some cities with respect to 
this point seem to indicate such an undesirable state 
of affairs. 

The industrial work of children is a sad chapter in 
history which lies outside the scope of this book; and 
we can only refer the reader to the excellent work of 
Agahd in Berlin, who has done much to further the 
rights of German children in such matters. The work 



124 SCHOOL HYGIENE 

done by Leubuscher in Sachsen-Meiningen shows the 
aid that can be given by the school physician in this 
respect. Further, nurses ought to be a great aid in 
this direction. 

The conditions of compulsory homework are some- 
what different in various secondary schools. Here the 
complaint of too much work has been and is so 
frequent that school boards in various countries have 
felt obliged to pass regulations stipulating the length 
of time beyond which the pupil shall not be taxed. 
That such regulations are not, however, strictly 
adhered to is evidenced by the remark of the Prussian 
Minister of Education, von Gossler, in an address 
made by him in 1890 before the Prussian legislature: 
" The number of hours of homework is indeed fixed by 
decree but all attempts at enforcing the regulations, 
all efforts toward changing conditions, are futile 
because the pride of teachers, in consequence of an 
ambition which is in itself very estimable but which 
should not be supported, tempts them, particularly 
in the larger cities to lay greater stress on homework 
than is in accord with my views." This expresses 
the situation exactly. It is true, no teacher in the 
secondary school desires to injure the health of his 
pupils, but many a teacher in his eagerness to have the 
pupils shine in his particular subject forgets that he 
himself is but a link in the chain. Often the true state 
of affairs is only discovered by interviewing the parents. 
For more than twenty years in the Grandduchy of 
Hessen it has been the rule to ask the opinion of 
parents and reliable pupils concerning homework 
conditions. A specialization of control by having 



a 



THE HYGIENE OF INSTRUCTION 125 

one teacher supervise the amount of homework to be 
assigned in each department, or a single competent 
supervisor for all the work of the school may avert 
much harm. 

It is, of course, difficult to demonstrate the unhy- 
gienic effect of overwork when there is no regular 
medical inspection concerning health and develop- 
ment. To ascertain the exact effect of homework, 
Key of Stockholm made a study of ten high schools, 
accommodating bo3^s of eleven to nineteen years, in 
different parts of Sweden. The average time spent 
on homework was computed with the assistance of 
the parents. His results show that of the total 
number of 3,968 pupils, the homework of 1,809 
covered a longer period than the avera^ time, 
while 2,159 worked less than the average number 
of hours. Among the 1,809 pupils, the percentage 
of illness was 47.9, among the 2,159 it was only 
44.7; that is, the group that worked a longer 
period at home had 3.2 percent more sickly indi- 
viduals. An analogous investigation made with re- 
gard to the 1,873 pupils in all the high schools of 
Stockholm showed the percentages of sickly pupils to 
be 56.1 and 50.8 respectively; there were 5.3 percent 
more sickly scholars among those who spent more 
than the average time on their homework. Further 
investigations have shown that those who work the 
longest at their lessons are often not the dull pupils, 
but on the contrary, the bright and conscientious who 
desire to meet their school obligations very fully. 
The claim that it is the outside work, such as music 
and language lessons, which tax the pupil unduly can 



126 SCHOOL HYGIENE 

be made only after we have accurate data on this 
point. So far as boys are concerned, we can cite the 
investigation made in Sweden, which covers thousands 
of pupils. This showed that only one-fifth of the 
boys had extra lessons which required on the average 
from four to five hours work per week of the pupil. 
Gymnastic home exercises were included in the cate- 
gory of extra work. 

It is deplorable that such illuminating research 
studies as are undertaken in Sweden are not made in 
Austria or Germany, as well as in other countries, 
for it is, of course, impossible to affirm that conditions 
everywhere are the same as those that have been 
cited. The smaller studies which Doernberger and 
Grassmann have made in Bavaria, however, show that 
the children there lack sufficient time for recreation, 
which they require for sound development. 

Another point which must be brought out in con- 
nection with taxing homework is the fact that chil- 
dren, especially those in the higher schools, do not 
really digest the matter presented to them. In this 
respect also Key's investigations afford insight into the 
difficulty. Patzak of Prague has likewise made 
scientific researches as to the degree of real under- 
standing which pupils have immediately after they 
have been taught in school, and finds most discourag- 
ing results. It can not be said too often nor with too 
much insistence that every teacher should convince 
himself at each step in instruction that the subject 
has been understood before he proceeds further. 

But the teachers as a whole can not rectify all the 
evils of homework. As already indicated a great 



THE HYGIENE OF INSTRUCTION 127 

drawback lies in the overcrowded class. This 
circumstance alone, where the ideals of the teacher 
are ambitious, is apt to lead to overpressure. Another 
difficulty may be the zealous supervisor. 

Extra Work. — On the whole, extra lessons play but a 
minor role in homework, especially in the case of 
boys. It is true that with girls the music lesson is a 
more important factor. Key found that in the 
secondary school of Sweden 70 percent of all the girls 
devote on an average one hour daily to music. This 
finding is corroborated l)y Waetzold from the sta- 
tistics of I^erlin schools. On the other hand, the work 
which bo.ys in higher schools do to earn money is 
often exceedingly taxing, as l?.oller of Darmstadt 
(Germany) has shown by the drastic exampl^ which 
he gives. 

Examinations. — l!]xaminati()ns, like homework, are 
unav()idal)le, and like the latter, may be injurious to 
health. The fear of examination is in itself a form 
of neurasthenia which frequently appears in industri- 
ous, well-pre])ared children. 

Above all, the examination (piestion should be quite 
clear. If oral, the pui)il should be allowed to tell 
what he knows without being interrupted by further 
questioning which may disturb his train of thought. 
An exception to this might be made in mathematics. 
No child should be ridiculed for his attempts. The 
pupil should not be allowed to remain in ignorance as 
to whether he has passed the examination or not. The 
object of withholding this information, i.e., to stimu- 
late the child to renewed efforts, cannot be justified. 
If the classes are too large and the material to be 



128 SCHOOL HYGIENE 

covered is too extensive to permit of frequent tests, 
it is not fair to make the child suffer because of this 
lack in school arrangements. It is to be recommended 
that, if possible the examination should come at the 
beginning of the lesson, before new matters are taken 
up, so as to relieve the mind of the child. 

Written examinations often cause great nervous 
strain. For this reason, it might be well not to let 
the pupils know the exact day of the examination, so 
that they will not worry beforehand and also do less 
efficient work at the examination. 

The written examination should be such that the 
average pupil can finish within the designated time, 
otherwise the fear of not having enough time and the 
strain of hurry will be added to the already existing 
condition of excitement and anxiety. The tax that 
examinations make upon children is recognized in 
statutory previsions made in many countries. In 
Austria the requirement is that no greater value shall 
be attached to written examinations than to oral. 
The same tendency is expressed by the Prussian de- 
cree of 1911. It is a most objectionable arrangement 
for teachers, who can not because of the large number 
of pupils examine often enough, to depend upon the 
final examination to decide the child's standing in the 
subject. 

Graduation Examinations ("Reifepriifungen"). — 
There is a great deal of discussion nowadays about the 
advisability of graduation examinations, and opinions 
on this score are divided. We are interested here in 
the question of the graduation examination being 
objectionable on the grounds of health, but we can not 



THE HYGIENE OF INSTRUCTION 129 

answer for all countries — even if we had the temerity 
to attempt it — because valid conclusions can only be 
based on exact proof. It is regrettable that with a few 
exceptions (Leubuscher in Meiningen) no attempt has 
been made in the various German states for regular 
physical examination of the pupils in the upper classes 
during the critical period. My assumption that such 
examinations, together with the period of preparation 
which they must entail, must be injurious to health, 
is based on the researches made in other countries with 
respect to the examinations given to ascertain the 
pupils' knowledge of a wide extent of instruction 
matter. The authorities in this field are Binet of 
Paris, who examined the applicants for the teachers' 
examinations; Ignatieff of IMoscow who ^amined 
pupils of a surveyors school; Iwliew who made an 
examination of the girl students in a Bulgarian school; 
Kosinzoff who examined the boys of three of the higher 
schools of southern Russia; and Bonoff's work with 
regard to the graduation examinations {Ahiturienten- 
examen) in Sofia. The investigations made by these 
authorities were mostly with regard to metabolic 
body changes. It can not, of course, be asserted that 
the conditions in the schools of these countries are 
identical with those in central Europe, and no authori- 
tative statement can be made without a basis of exact 
facts. Conditions are different in America, where 
pupils in the upper grades of the secondary schools 
have to a certain degree the liberty of choosing their 
subjects. Prussia has lightened the requirements 
through the compensation system, and in Austria the 



130 SCHOOL HYGIENE 

graduation examination has undergone considerable 
alterations, which diminish its disadvantages. 

Overwork. — There can be no doubt that classwork, 
homework and examinations are a severe tax upon the 
health of children and that this tax may readily ex- 
ceed the normal limit. So as not to reach the danger 
point, the child must above all have sufficient sleep, 
for as has been already mentioned, he not only needs 
to replace tissue, but he also needs to grow. During 
sleep the tearing-down processes are diminished and 
consequently there is opportunity for new growth. 
In this connection, the valuable investigations of Key 
of Stockholm must again be cited. He found that the 
time of sleep for the pupils in the high schools of 
Sweden was one hour, and in some classes much more 
than one hour, less than the physiological require- 
ment. This finding does not apply to city children 
alone, for his investigation included 13,627 children 
in all parts of Sweden, that is practically all those at- 
tending the higher schools. The statistics of these 
eleven- to nineteen-year-old pupils show that the 
j5eriod of sleep is progressively less the higher the 
grade a pupil occupies for his age. The explanation 
for this loss of sleep can not be sought in the home; the 
greater demand of the school must be held responsible. 
On this point, Schmid-Monnard has furnished ad- 
mirable data in an investigation made in Halle (Ger- 
many) . By tabulating the period of sleep for the ele- 
mentary school children of that city and comparing it 
with the sleeping time of children of the same age in the 
higher schools, he found a curtailment among pupils 
attending the latter. Leubuscher instances the fre- 



THE HYGIENE OF INSTRUCTION 131 

quency and seriousness of nervous disturbances in the 
upper grades of higher schools as due to mental strain. 
Chlopin of St. Petersburg bases similar conclusions 
on an investigation of 104,696 pupils in the secondary 
schools of entire Kussia. 

Out of the mass of statistics which Key has given 
us and which is so comprehensive as to make his con- 
clusions of real value, we wish to make application of 
one fact — the relation between sickness and develop- 
ment. That the increase in body weight is not a con- 
stant one for all ages is a well-known fact, but Key has 
also demonstrated a decided increase in sickliness 
during the years of school life, and he finds that this 
sickliness cHrve has a pronounced relation to the 
weight curve. This fact is significant for i\^ school 
or, more correctly stated, it ought to be significant. 
If, for instance, as was the case in Sweden, it is found 
that theie is a decided increase of sickliness or a weak 
state of health at a certain age, and a corresponding 
decrease in growth, that period, should be regarded 
as one of lessened resistance, and care should be taken 
to ward off all harmful influences. There are, how- 
ever, no cases on record where a curriculum has been 
modified to meet such conditions; not even an attempt 
has been made in other countries to verify Key's 
findings. It must be emphasized that the school has 
a higher function to perform than merely to give in- 
struction, and that improvement of existing conditions 
must be based not on theory but on a firm foundation 
of observed and verified facts. 

Punishments. — Punishment for wrongdoing can 
never be quite eliminated from the school, and the only 



132 SCHOOL HYGIENE 

question that remains is, what forms of punishment 
are least objectionable, hygienically considered? 
We must consider four types — censure, punishment 
work, depriving the child of freedom, and corporal 
punishment. With regard to the whole subject of 
punishments the medical inspector may be of great 
help, for, as is frequently the case, the cause of mis- 
takes may lie in certain pathological conditions of the 
eyes, such as farsightedness, astigmatism, strabismus, 
rather than in inattention. The ^ame may be said 
of defects of hearing, especially if the difficulty is 
not constant but intermittent. Some children void 
urine involuntarily, others can not control involun- 
tary twitchings of the muscles. Mistakes are also fre- 
quently made in judging the mentally defective. 
Certainly no humane teacher would desire to punish 
a child who because of physical or mental disabilities 
is not responsible for his mistakes. 

The work assigned as punishment should not be 
such that the child is deprived of necessary recrea- 
tion, and when he does remain in school during play 
time it should be under the supervision of a teacher, 
for it has been found that unsupervised children fre- 
quently fall into bad sexual habits. The brief recess 
periods should never be forfeited. To stand for a 
long time is extremely fatiguing, and little children 
should not be punished in this way for longer than 
ten minutes; the punishment of standing through the 
whole period of the lesson is also too severe for larger 
children. It is dangerous to put children in the cold 
halls in winter, while that refined kind of horror of 
lying flat on a hard floor or standing with arms 



THE HYGIENE OF INSTRUCTION 133 

extended belongs neither in the school nor the 
home. 

Corporal Punishment. — The most difficult question 
arises with reference to corporal punishment. It 
can not easily be dispensed wdth altogether, where it 
has once been in practice, because of the supposed 
disastrous effect upon discipline; badly brought up and 
unruly children will immediately assume an aggres- 
sive attitude. But notwithstanding these difficulties 
which are those of transition, the tendency should be 
toward doing away with whipping altogether. Not 
to mention the injury to the dignity of the child, 
facts can be cited from countries where corporal 
punishment is still in use, which leave no doubt what- 
soever that this type of punishment is re%)onsible 
for some horrible malpractices, the majority of which 
never come before the public. It may happen that 
even mild whippings lead to serious results and death, 
or whipping may excite sexual feeling and attract 
teachers with sadistic tendencies, as for instance in 
the sad case of Dippold. It is possible to give a 
long list of the restrictions which prevail in countries 
where corporal punishment still persists, for instance, 
that the headmaster shall be responsible, and that the 
school physician and the school director must be con- 
sulted, also that girls shall be spared, and that no 
children beyond a certain age shall be punished. All 
these provisions are made for the purpose of limiting 
corporal punishment and averting the possibility of 
the child being whipped in anger. Another indication 
of the tendency to do away with corporal punishment 
is the preference shown for teachers who can achieve 



134 SCHOOL HYGIENE 

satisfactory pedagogical results with the minimum 
number of whippings. In Finland, for instance, 
while corporal punishment in the school is not pro- 
hibited, it is never practised because public opinion 
is against it. In Belgium, France, Hessen (Germany), 
Japan, Austria, some cantons of Switzerland and most 
of the United States it is prohibited. It can readily 
be seen that in countries where whipping still prevails, 
teachers are loath to part with it, especially in classes 
of from eighty to one hundred unruly boys. In such 
a case a tired, irritated teacher can hardly be blamed 
for resorting to physical force, but the question of the 
wisdom of such acts — it may be that the wrong child 
is whipped — still remains open, and it is very doubt- 
ful if children are morally improved thereby. Very 
likely, if the teacher had only half the number of 
pupils, that is forty, he would be very ready to 
dispense with corporal punishment. It is undoubt- 
edly a fact that many whippings can be attributed 
to just such circumstances as those cited above. 

Where corporal punishment is practised, the follov/- 
ing points should be observed. The teacher should 
not box or pull the ears of the pupil; he must not hit 
the child on the head or neck, nor use his hand, a 
book, a ruler or a heavy stick; he must not pull or 
push the child about, or punish him at his, the child's, 
desk. To spank the child on that part of his anatomy 
which seems best able to bear this punishment may 
excite sexual feeling. Many aspects of the subject 
need to be considered, and even when corporal punish- 
ment is hedged about with restrictions it is a source of 
distress to all concerned. 



THE HYGIENE OF INSTRUCTION 135 

Again, in the public schools of large cities we find 
children who have become vicious and unruly through 
neglect at home. Such need first of all pity, rather 
than punishment. It is probable that the practice 
of whipping in school would be greatly lessened if 
such unruly children could ])e segregated in special 
schools with small classes — which might obviate the 
necessity of later sending them as delinquents to 
reformatories. It is, of course, better still to prevent 
such a condition of affairs by the enactment of 
legislation concerning the duties of parents and by 
such adequate measures as institutions for ill-treated 
children, but the time is not yet ripe nor are the means 
at hand for the realization of these ideals. 

Pupils in secondary schools should net be subject to 
cori)oral punishment. The dishonor attending cor- 
rection is felt very keenly during these years, especially 
at the beginning of puberty, and it may be disastrous. 
Even threats of corporal punishment have been known 
to have had bad effects. Lentz cites the case of a pupil 
who committed suicide ])ecause he was to be whipped. 

School Suicides. — It is probable that while the im- 
mediate cause of these school suicides may be a feeling 
of injured pride, fear of punishment, dread of ex- 
minations, or unhappy love, the underlying cause is 
pathological, and the tendency may be an inherited 
one. The suicides of school children, especially of 
boys in high schools, are far too frequent, as Eulenberg 
has shown with regard to the schools of Prussia and 
Chlopin for those of Russia. It behooves the school 
to realize this situation and to do everything in its 
power to avoid such disasters. 



136 SCHOOL HYGIENE 

Other Punishments. — To ask a child to be the 
bearer of a note reporting his deUnquencies to the 
parents or to bring a message of reproof, means simply 
to lead him into temptation. The psychic influence 
of this upon a sensitive child whose parents are 
severe may affect his health unfavorably, not to men- 
tion the moral danger of lying and subterfuge. 

The kind of punishment which might really be 
effectual is to deprive the child of some pleasure — 
praise, play, swimming, etc., although at present the 
school offers small opportunity in this direction, for 
school pleasures are few. The prospect of being 
deprived of the shower bath has been found to be an 
effective pedagogical measure in the schools in Munich, 
and analogous cases are reported from English schools 
when children are not permitted to participate in the 
sports of their companions. 

Vacations. — That vacations are beneficial to health 
is a well-known fact, though we lack scientific in- 
formation as to the desirable length and distribution 
of vacations in the school year. The findings of 
investigators in Denmark, Germany, and Scandinavia 
are in general accord, i.e., that the children's gain in 
weight during these free peribHsisproportionatery 
greater than during other times, although in connection 
with this statement it must be said that we do not yet 
know what part seasonal changes play in the growth of 
children at various ages, nor do we know for large 
numbers of children the comparative increase in 
weight by months o f those in school and those who are 
free. To solve the last-mentioned problem, investi- 




THE HYGIENE OF INSTRUCTION 137 

gations need to be conducted in a country where great 
numbers of children are still out of school. 

Summer Vacation. — That a long summer vacation 
is beneficial from the pedagogical as well as from all 
other standpoints is shown by an example from Russia. 
In that country during the cholera epidemic of 1891, 
the summer vacation was lengthened by two weeks for 
37 boarding schools. The results with respect to 
examinations and general attainments for the follow- 
ing school year were found to be so satisfactory that 
it was resolved thereafter to adopt the longer vacation. 
This instance likewise illustrates the value of the experi- 
mental method in education. In advocating the 
experimental method we do not, however, mean to say 
that every school should try a longer vacation one year 
and a shorter one the next; this would be a contradic- 
tion of the word '' experiment." If, on the other hand, 
a large number of pupils, at least 10,000, in a selected 
number of schools in both city and country, were 
studied with respect to the effects of a lengthened 
vacation upon psychic development, condition of 
health, and school attainments, in comparison with a 
like number of children whose free period remained 
unchanged, really valuable data might be obtained. 
The best time for the summer vacation naturally 
varies with climatic conditions. In the northern hem- 
isphere the months of July and August are preferable 
because of the high temperature and also because the 
long days of those months permit the children to be 
out-of-doors the maximum number of hours. Schuy- 
ten of Antwerp, in studying over 600 school children 
from seven to fourteen years of age, with respect to 



138 SCHOOL HYGIENE 

their spontaneous attention to reading in relation to 
varying outdoor temperatures, found the lowest per- 
centages during July (August and September were 
vacation months and no observations were taken); 
he found that the attention curve rises from October 
to January and then descends till July. The long 
vacation should at all events come at the end of the 
school year. When this is not the case, the vacation 
will not be of the greatest benefit because of the 
anxiety which some children will feel about their 
work. 

Mid-term Vacations. — In addition to the summer 
vacation, a number of mid-term intervals must be 
considered. The most desirable time would seem to 
be at the end of December and beginning of January, 
and the latter part of March or early in April. It 
is better not to regulate the vacation according to the 
date of Easter which changes from year to year, and to 
allow only the church holidays at Easter. The period 
from March to April is the time of highest morbidity 
in the year, and hence peculiarly significant for a va- 
cation, so that unfavorable influences may be miti- 
gated as much as possible. 

This statement is based on statistical data obtained 
from the five children's hospitals in Vienna and covers 
an analysis of the records of 40,000 children of all ages 
up to fourteen years (1898 to 1904). A rising mor- 
bidity from the opening of school in September to the 
end of the calendar year was observed, with a high 
point in March and a maximal rise in April. In the 
figures of Zirngast, of Mahrisch-Schonberg (Austria), 
who studied the absence records of eleven to fifteen- 



THE HYGIENE OF INSTRUCTION 139 

year-old children in the four lowest grades of the higher 
schools for a period of twelve years, there is a steady 
ascent in the curve from December to Januarj^, and 
the greatest rise in March. Lobsien found that in 
Kiel (Germany) where the new school year begins in 
April, the greatest number of absences also occurred 
in March; there was a decided drop in the absences 
for April. 

The great significance of rest on the seventh day is 
hallowed b}- religious custom. Sunday should not 
only be a day of freedom from school, l^ut the demands 
of the week should be so regulated that it shall not be 
necessary to do any home work on that day. This 
may also be said of vacations. During the summer 
especially, children should not be required to^lo any 
school work, even that disguised in the form of desig- 
nated reading. Such tasks spoil the vacation for 
many children, and moreover small educational benefit 
is derived from this practice, for the children will 
usually leave the work until the last minute before 
school. Much has been forgotten during the vacation, 
and it is not fair to expect that at the oi^ening of school 
the children shall be as familiar with the subject as 
they were at the close of school. The tasks assigned 
for the Christmas and spring vacations should not ex- 
ceed the demands ordinarily made for the next day. 

Suspension of School on Warm Days. — Suspen- 
sion of school during very warm afternoons has become 
a general practice in Europe, since it was officially 
recognized in Wtirttemberg (Germany) in 1870; the 
custom existed in Dresden and Leipsic even in the 
middle of the century. No specific temperature of 



140 SCHOOL HYGIENE 

excessive heat can be given, for much depends upon 
local conditions. Thus in a small town with only 
twenty pupils in a room which opens to the east, the 
school work may proceed with comfort, even though 
the day be hot, while on the same day, conditions 
would be unbearable in a city school with sixty pupils 
to a class room opening southward on a street. 

Vacation Colonies or Camps. — The vacation colo- 
nies are a form of school welfare work most worthy 
of encouragement. This work was started in Copen- 
hagen in 1854 for poor children in need of fresh 
air, who were taken to families in the country; but, 
of the vacation colony in its modern sense, Bion of 
Zurich is the originator. He started in 1876 to take 
groups of city children in charge of their instructors 
out to the country. For small camps, the family plan 
of living is very desirable. Before starting out, the 
children should be examined by a physician, weighed, 
and then re-weighed at definite intervals during their 
stay at the camp, so that those who show no gain may 
be especially cared for. Such deficient children should 
not be permitted to take part in long tramps; they 
should be allowed to remain only a few minutes in the 
water, should rest after dinner or be sent to bed- 
earlier than the others. The regime at the camp 
should include a good breakfast eaten after some 
exercise, a good dinner in the early hours of the 
afternoon, and an early, light supper with soup and 
milk dishes, but no meat. 

The finest vacation camp in Europe is on the shores 
of the beautiful Lake Abersee, where 500 Vienna 
boys, eleven to twenty years of age, of the Latin and 



THE HYGIENE OF INSTRUCTION 141 

modern schools, have camped since 1911 during their 
summer vacations. The colony covers an area of 
400,000 square meters and is open from the middle 
of July to the middle of September. Any friend of 
youth who visits the romantic Salzkammergut should 
pay a visit there. 

Excursions in Vacation. — Vacation picnics, vacation 
sports, and holiday trips, are admirable institutions 
for city children. It need hardly be said that on these 
occasions and also in the vacation camps, none of the 
children, not even the older ones, should l)e permitted 
to partake of alcoholic beverages. Milk is a suitable 
drink. If the drinking water is not known to be 
absolutely pure, it should be boiled and a little lemon 
juice or tea added. In this category of vacation activ- 
ities also come the extensive walking tours of children 
accompaui(Ml by their teachers. 

Recreation Day Camps and Open-air Schools. — The 
recreation day camps were first established near 
Charlottenburg in 1902 and arose out of the Red Cross 
recreation center work started in 1900. They have 
now spread over the entire world, and have led to the 
establishment of recreation piers, roof playgrounds, 
etc. These day camps are usually located in a re- 
stricted wood near the city and on a car line; on the 
grounds are a number of huts (barracks). The 
children are taken to the camps in the morning and 
return to the city at night. In the forest school 
(Waldschule) of Charlottenburg, near Berlin, the chil- 
dren have received regular instruction since 1905. 
Open-air schools are now a growing educational fea- 
ture in America, Germany, England and Austria. 



142 SCHOOL HYGIENE 

5. Boarding Schools 

Life in a boarding school offers many health advan- 
tages, especially to pupils of the higher schools in the 
large cities, but also some grave disadvantages. The 
advantages are that there is a better division and 
use of the pupil's time than at home, physical exer- 
cise is on a better basis, and the accessibility of physi- 
cians who make regular examinations of the pupils' 
eyes and teeth, keeps them in better condition. These 
advantages apply only to good boarding schools. 
The disadvantages, on the other hand, are the rapid 
spread of infectious diseases and sexual irregularities. 
The ideal arrangement for pupils of the higher 
schools would be to combine the advantages of the 
home with those of the school. That is, if the child 
could go in the morning to a good school, remain there 
for the entire day, and return to the home at night, 
the disadvantages of the boarding school would be 
obviated, while the advantages remain. In this 
way, the home influence would not be lost. Groups 
of small lodging houses, not accommodating more 
than twenty pupils and each house in charge of a 
married instructor, would be most desirable for board- 
ing schools. The relationships thus established 
would be those of a family with many children, 
and the pupils would escape the disadvantages of 
overcrowding. 

What has been said about the construction of school 
buildings applies in general also to boarding schools. 
In addition, of course, certain sections must be set 
aside for more personal use, for a kitchen, dining-room, 



THE HYGIENE OF INSTRUCTION 143 

study rooms, hospital accommodations, and sleeping 
quarters. The latter offer the greatest difficulty, for 
while with small separate bedrooms the possibility of 
conversation after retiring is avoided, they make super- 
vision of the individual child more difficult. Ventila- 
tion in small rooms is also apt to be deficient, and the 
difficulty of cleaning presents itself. Common dor- 
mitories can be more readily supervised, and are 
easier to ventilate and clean, but in them the pupils' 
freedom as to intercourse is less restricted. An 
adjustable screen by the side of each bed with a 
curtain which can be drawn when the pupil is dressing, 
untlressing, or washing, protects modesty. The beds 
should be at least an arm's length apart. Akoholic 
drinks should be absolutely excluded from boarding 
schools. 

Open Air Boarding Schools. — Special reference 
must l)e made to tlie open air l)oarding schools in the 
country. The first of this type, called ''The New 
School," was started by Reddie at Abbotsholme, 
Derbyshire, in 1889 for boj^s. In Germany the first 
appeared in 1898; later similar schools were started in 
Austria and Switzerland, and now we have such 
institutes for girls as well. The chief hygienic char- 
acteristics of these schools are — simple, plain food 
(alcohol being absolutely excluded), regular bathing, 
sports, and the alternation of mental with physical 
work. The latter includes working in a garden, field, 
and workshop. To harden the physique of the pupils 
they sleep frequently in the open air. Intellectual 
work is restricted to the morning hours. The educa- 
tional ideal of these schools is to awaken self-reliance 



144 SCHOOL HYGIENE 

and to establish closer companionships between teacher 
and pupils. It has been reported that in the zealous 
application of their rules, in sleeping out of doors even 
in very cold weather, in exposing the limbs of the 
children to the cold, these schools have gone too far; 
but it can not be denied that the training which chil- 
dren receive in institutions of this type is far superior 
to ordinary school training, and not only with respect 
to physical health. Unfortunately, such. schools can 
be available to only a small proportion of the school 
population. 



Ill 

INSTRUCTION IN HYGIENE 

It is clear from tlic foregoing discussions that a 
systematic and incessant campaign of school hygiene 
cannot be carried out if the teacher within the school 
is not informed on these subjects or does not know 
how to put these ideals into practice. The school 
physician, of whom mention will be made later, can not 
replace the teacher in routine matters of hygiene; the 
former visits the school only at dafinite times, while 
the teacher's influence is continuous. Hence it is 
absolutely necessary for the teacher to possess at 
least some specific knowledge of school hygiene. It is 
the duty of the teaching profession to call attention 
to hygiene requirements, so that blunders will be less 
frequent when new school buildings are erected, or 
old ones are rebuilt, but a wider and more fertile field 
for the propagation of hygiene ideals is the classroom 
where a consistent regard for these ideals is demon- 
strated daily. Another avenue for the furtherance of 
school hj^giene lies in scientific research work for those 
teachers who are equipped in this direction and who 
can devote sufficient time to the work. The hygiene 
of instruction especially offers numerous problems for 
investigation. Of the greatest individual and social 
significance is the instruction of the children in matters 
of hygiene. Talks with parents concerning the rearing 

145 



146 SCHOOL HYGIENE 

of children, and discussion of unhygienic conditions 
in the community, are other effectual means. Finally, 
a not to be despised advantage of this knowledge is 
the benefit which it may be to the teacher himself, in 
helping him to guard his own health in an arduous 
profession. 

Hygiene in Training Schools. — It would be espe- 
cially useful if matters of school hygiene were included 
in the last year's curriculum of the training school, 
so that the young teacher may have not only a theo- 
retical, but also a thoroughly practical knowledge. It 
would be of still greater advantage if the training 
school could offer a variety of conditions, in order that 
the teacher may be instructed how to meet the situa- 
tion with regard to varied school conditions, as found 
in both city and country. 

It is also most desirable for the teacher to have suffi- 
cient medical knowledge to recognize the first signs 
of disease, particularly the contagious diseases . of 
childhood, so that in suspicious cases, when a child 
complains of feeling ill, or has a sore throat, difficulty 
in swallowing, headache, coughs continually or sneezes 
without mucous secretion, or has fever, he can be 
sent home at once for medical examination. In lo- 
calities where many cases of oholera or typhoid fever 
have occurred, a knowledge of first symptoms and 
what to do when they appear, may help to prevent 
epidemics. 

The most suitable person to impart instruction 
in personal and school hygiene in the training school 
is undoubtedly a well equipped physician — a demand 
which is more easily made than fulfilled, for there 



INSTRUCTION IN HYGIENE 147 

seems to be small desire on the part of physicians to 
prepare themselves carefully in the way necessary 
to fill such a post; hence the work must often be done 
by teachers. If the position of the school physician 
at the higher schools were an official one, i.e., if in 
addition the physician were the physical director in 
charge of the physical training of the school, or if 
this post should not offer enough occupation, perhaps 
also the natural history instructor, the difficulty might 
be obviated and the physician would be brought into 
closer contact with the school. A paragon institution 
is the Department of Hygiene in the College of the 
City of New York, where Storey is doing excellent 
work in medical inspection, physical education, and 
instruction in hygiene. ^ 

Teachers and physicians of the old order who have 
had no scientific training in hygiene, are not as a rule 
favorably inclined toward the "innovations" of 
hygiene. If, therefore, a young teacher who is well 
prepared on these subjects takes up his work with 
great enthusiasm in a school where the principal and 
most of the teachers belong to the old regime, he will 
seriously jeopardize his interests if he tries to intro- 
duce reforms too quickly. It is well for him to be 
guarded in his actions, to feel his way, gaining first 
the trust and confidence of a number of his co-workers 
before he attempts to put new principles into effect. 
On the other hand, it goes without saying that the 
teaching profession also includes many who have grown 
gray in the service and who keenly welcome the new; 
in general, it can be said that the teaching profession 
is distinguished by an eagerness to widen its fields of 



148 SCHOOL HYGIENE 

knowledge. The reading of literature on school 
hygiene and the attendance at lectures on the subject 
demonstrate the extent of this open-mindedness, and 
the older teacher possesses this great advantage over 
the young instructor just out of the training school — 
he is in a position to correlate the theoretical and new 
with his personal observation and ripe experience. 

Hygiene in Elementary Schools. — The school offers 
a multitude of opportunities for the practical demon- 
stration of hygienic living; the daily conduct of the 
teacher in this respect as in others should serve as a 
model to the children. Instruction in personal hygiene 
should be a recognized school subj ect . A definite num- 
ber of hours during the year should be devoted to teach- 
ing the essentials of right living as it concerns food, 
work, care of the body in all its parts, safeguarding it 
against contagion, etc. This instruction may be sup- 
plemented by definitely planned and suitable reading. 
Little books of health rules, of which the first to be 
published in Germany was put forth by the teachers' 
association of Berlin, and of which many different 
kinds can now be obtained, are useful in helping the 
children to gain a clear idea of fundamental principles. 
Placards with maxims in verse form which appeal to 
the eye are useful for the schoolroom; the children 
read and remember the hygienic lessons which they 
convey, especially if attention is drawn to the motto 
as occasion may demand. The older folklore may be 
lacking in proverbs which express the ideals of the 
modern day, but it is not difficult to meet the need by 
creating new maxims. Such simple rhymes as the 
following may be effective : 



INSTRUCTION IN HYGIENE 149 

When before the board we sit 
Only cleanly hands are fit.* 

The oldest instance of instruction in hygiene in 
public schools is furnished by Eichstadt (Germany) 
which included this provision in the school regulations 
of 1785. 

Hygiene in High Schools. — What has been said up 
to this point about instruction in hygiene applies par- 
ticularly to the elementary school, but the secondary 
school also has its own problem in this respect. In the 
first place, it is essential for the teacher in the sec- 
ondary school to be thoroughly well equipped in 
hygiene. His schoolroom duties are largely identical 
with those of the elementary school teacher, but of 
him special discretion is demanded because of the 
intensity and quantity of work required of pupils 
in the liigher institutions. 

In high schools we find those who desire to qualify 
for teaching positions. Hence it is desirable, as is 
customary in Austria and in some parts of Germany, 
to provide special lectures in hygiene for high school 
students. The interest shown among high school 
teachers has on the whole been more lax than in the 
elementary school, and yd the long, hard tasks of 
the higher school, which fall upon the pupil during 
the pubescent period, make it imperative for the 
teacher never to lose sight of this larger viewpoint of 
health. Matters of health must be taken seriously. 
During the high school age, as well as earlier in their 
school career, children need special instruction in 

* Vor dem Essen merk' die Regel: 
Wasch' die Hande, putz' die Nagel. 



150 SCHOOL HYGIENE 

hygiene. Such instruction is particularly significant 
for the high school, not only because the importance 
of community hygiene is then beginning to be appre- 
ciated, but because the pupils of the higher schools 
will eventually compose the greater part of the class 
which will be instrumental in supporting the hygienic 
ideals of the community. In view of the significance 
of the subject, its introduction into the high school 
curriculum in Europe has frequently been agitated; 
but it is clear that where it does not replace another 
subject which is dropped, the extra work will 
only mean an additional burden upon the pupil 
— an unhygienic procedure. Therefore, for the pres- 
ent we must content ourselves by stimulating the 
interest of high school teachers, to the end that matters 
of hygiene may be embodied in the books' and dis- 
cussions on various other subjects. The wise teacher 
can then make incidental mention of hygienic points 
as opportunity may offer. Or, it may be possible for 
the upper classes to curtail other courses, for instance 
those in nature study, and substitute hygiene, pro- 
ceeding gradually with a view to training future 
teachers. When the instructor in hygiene is a physi- 
cian, he should be thoroughly trained in school 
hygiene. 

Of the various subjects included under hygiene, the 
use of alcohol and tobacco, and sex problems require 
detailed discussion 

Alcohol. — The results of scientific study leave no 
doubt that alcohol, even in small quantities, is in- 
jurious to children. Alcohol is a poison, and its use 
by children should be prohibited. The statistics in 




INSTRUCTION IN HYGIENE 151 

secondary schools of delinquents and the studies that 
have been made into the causes of insanity, as well as 
the frequent occurrence of venereal infection among 
students who use alcohol, all show to what extent the 
misuse of alcohol may lead. The campaign against 
this poison is an unquestionably justifiable one; its 
significance is still underestimated by many. That 
the alcohol problem concerns the school population 
is witnessed by the prevalence of the evil practices 
found among German high-school students; these 
practices are copied and carried on by the pupils of 
the lower schools in their secret societies, and so the 
evil spreads. The vices thus propagated are a blot 
on the morality of Germany and Austria. One of the 
saddest sights is the teacher addicted to drink. 

Theoretical teaching alone will not cure the evil, 
and the influence of the school must extend to the 
hours spent out of school as well, to the extent that 
alcoholic drinks may be excluded from the social 
gathering of students and the midnight carousals be 
condemned by pul)lic opinion. The school may help 
by prohibiting the use of alcohol in any form in its 
recreation camps, on walking tours, etc. The teacher 
who in the interests of his j)upils, because of the 
example of abstinence which he sets, is willing to 
sacrifice his own pleasure is doing a genuine service 
to children. 

Tobacco. — Tobacco, also is to be condemned for 
school children because of the many injurious results 
that arise from its use and because of the manifest 
tendency for the habit of smoking to spread among 
ever younger groups of pupils. 



152 SCHOOL HYGIENE 

Attempts have been made in many countries to 
combat the evils of drinking and smoking by legis- 
lative enactmen^t. In the United States, for instance, 
the act of Congress passed May 20, 1886, and which 
is in force in all states and territories, provides that 
every individual shall at some time of his life receive 
instruction in hygiene, with special reference to the 
effects of stimulants and narcotics. At least 20,000,- 
000 children come under the influence of this law. 

Sex Hygiene. — Another important and difficult 
problem concerns the instruction of the young in 
matters of sex. Next to tuberculosis, alcoholism and 
venereal infection are the two greatest evils — and 
preventable evils— which threaten the weKare of the 
human race. Masturbation during early childhood 
which is widespread among boys has injurious effects 
and prepares the way for other evils. The school must 
do its part to stamp it out, though it is very difficult 
to attack the subject directly in instruction, and 
the home must take practical measures to help. 
Much may be done through discussions at parents' 
meetings. In a number of German cities it has been 
the custom to deliver lectures* to those graduating 
from the higher schools on thfe dangers of too early 
sexual intercourse, but these measures in a remarkable 
number of cases come too late. An adequate amount 
of physical exercise with the opportunity for such 
exerc;ise, is one of the most important preventive 
measures. The city of Helsingf ors in Finland, through 

* Such lectures have been given by von den Stein in Diisseldorf, 
Sternthal in Braunschweig, Brennecke in Magdeburg, Stephani 
in Mannheim, Germany. They can be obtained in printed form. 



INSTRUCTION IN HYGIENE 153 

the efforts of Oker-Blom, has taken the longest step 
forward that has yet been made in sex instruction, 
by imparting information on these subjects to gradu- 
ates of the elementary schools. 

Girls of a suitable age should be instructed by 
women teachers about the significance of the monthly 
period and its hygiene. Such instruction is sometimes 
difficult in schools for girls where the teacher of 
hygiene is a young physician; but the difficulty can 
be obviated by putting this particular work into the 
hands of a woman teacher or by sending to the 
mothers of girls suitable printed matter, so that the 
mothers themselves may enlighten their own daughters. 



IV 



SCHOOL DISEASES AND MEDICAL 
INSPECTION OF SCHOOLS 



1 



Contagious Diseases. — School hygiene has arisen 
out of the need for correction of certain physical con- 
ditions which have been looked upon as intimately 
connected with school life. It is a universally recog- 
nized fact that such acute, contagious diseases as 
scarlet fever, diphtheria, measles and whooping cough 
are most frequently contracted in school. This is, 
of course, due to the fact that in the schoolhouse we 
find large numbers of children who are susceptible 
to these diseases, which are carried from one to the 
other in daily intercourse. The carrying of disease is 
a difficulty of the school which can never be wholly 
overcome, but it can be minimized to a considerable 
extent by preventive measures. 

Well-Hghted, adequately ventilated and clean 
schoolrooms, recreation rooms, playgrounds, small 
classes, shower baths, etc., are important means for 
the prevention of diseases; indeed, if their hygienic 
importance were fully recognized, it would perhaps not 
be as difficult as it is at present to secure sufficient 
appropriations for their maintenance. The particu- 
lar ways in which diseases may be transmitted — by 
the common drinking cup, by expectorations, the use 

154 



SCHOOL DISEASES 155 

of slates, kissing, etc., have already been mentioned. 
Poverty also plays a great role. In the sunless, damp 
cellar dwellings of the poor many an infected child lies 
without medical attention. This child has probably 
given the disease to others while he still attended 
school, and the contagion is carried further by broth- 
ers and sisters. The regulations of the school should 
prevent the spread of infections by excluding all those 
who show sym];)toms of disease, and keeping them at 
home during the time of illness. Children in the same 
household should also be i)revented from coming to 
school. Furthermore, care should be taken so that 
the excluded childrcMi do not mingle with their com- 
panions on the pla3^ground. This isolation should be 
lengthy enough to prevent all ])ossibility of iilfection, 
which varies with different diseases. 

Frequent inspection by the school physician is 
another means of prevention. The teacher if he is 
familiar with first symptoms also can do much to ward 
off infections, especially as he is in a position to know 
what is the normal condition of the child. A case 
of violent contagion which has spread through an 
entire class may necessitate closing the whole school, 
and at any rate, requires thorough disinfection. 

It is likewise desirable for the children to be informed 
about infections and how to avoid them; children 
should be asked to report immediate^ any departure 
from normal health. In the case of a spreading infec- 
tion, the parents should be notified so that they may 
watch their own children and keep them at home when 
the first suspicious symptoms occur. 

Our subject would grow to undue proportions if 



156 SCHOOL HYGIENE 

we attempted to discuss in detail all the physical 
disabilities related to school life, but two difficul- 
ties — nearsightedness and spinal curvature — demand 
attention. 

Myopia (nearsightedness). — The demand made 
upon the eyesight of children is very great. It is a 
matter of scientific knowledge that the number of 
children who are nearsighted and the degree of near- 
sightedness increase from grade to grade and from 
school to school as the children advance in school life. 
This fact which was first demonstrated forty-five years 
ago by Herman Cohn of Breslau in an examination 
which he made of the eyes of 10,000 school children, 
has since been corroborated by a number of other 
investigators. The blame can not be placed wholly 
upon the school itself; the homework, done often 
under unfavorable conditions, contributes its share. 
Another cause lies in the reading of badly printed 
books in a poor light, that of dusk, for instance. 

The argument has been advanced that nearsighted- 
ness is no disablement to an educated man, who works 
on nearby things and can see them with ease. That an 
argument of this sort should be advanced at all is 
astonishing. Common sense tells us that the near- 
sighted person can by no means be as well off as the 
man with normal vision. Moreover, not all near- 
sighted pupils will desire to become pedants or clerks; 
some might wish to become soldiers, sailors or foresters. 
The nearsighted man is greatly discomfited if he 
breaks or loses or forgets his spectacles, is humiliated 
when he passes an acquaintance on the street without 
recognizing him; he can not find his way about in the 



SCHOOL DISEASES 157 

country J or enjoy a beautiful view as keenly as a nor- 
mal-sighted individual. Disadvantages are already 
felt during childhood. K. E. Weiss says: ''With a 
diminished function of sight, fewer sense perceptions, 
and hence fewer concepts, are possible; the nearsighted 
child therefore enters school with a complex of mental 
images entirely different from that of the normal- 
sighted." No one who knows conditions as they are, 
and as they will no doubt long continue to be, will 
assert that all nearsighted children can get proper 
glasses; and even if they have such glasses given to 
them, they will not wear them. 

The school can not shield itself behind the above 
extraordinary argument, particularly as nearsighted- 
ness may lead to other evils, bad posture for instance, 
and bad posture in turn may still further increase the 
defect of the eyes. It has been pointed out by Berger 
of Krefeld (Germany) that nearsightedness in its early 
form can be corrected and the vision sharpened if the 
individual arranges his life so that he may have long- 
range vision; gazing at distant views in the country 
may help, according to Kertzsch of Quedlinburg 
(Germany). At least the muscle tension of accommo- 
dation is relaxed. 

Spinal Curvature. — Of the various malformations of 
the spine, all of which deform the body, lateral cur- 
vature or scoliosis is most to be feared. According 
to the degree of curvature, other evils, as disturbances 
in circulation, result. The relative number of children 
who develop spinal malformation during the first year 
of school life is very great, and the number increases 
steadily during the second year. That the school is 



158 SCHOOL HYGIENE 

to blame in part for this condition cannot be denied; 
though natural disposition plays an important role 
and, as in the case of nearsightedness, the home is 
also to be held accountable; it must be remembered 
that the homework which requires sitting is largely 
that of the school. The greater percentage of spinal 
curvature is found among girls, whose weaker muscula- 
ture and bone structure offer less resistance to harmful 
influences (cf. p. 120). Spinal curvatures once started 
are corrected with great difficulty; frequently it is 
impossible to straighten the bent back, and many 
parents later spend large sums of money and infinite 
pains trying to correct that which should have been 
prevented in the beginning. 

Subnormal Children. — The recognition of definite 
''school diseases" was the first incentive toward 
securing the services of the school physician, but since 
then the scope of the work has been extended, and the 
school physician to-day must examine children who have 
not yet been to school, but are about to enter. An 
examination of the school records of Wiesbaden 
(Germany) for 1898-1899 showed that of the 970 
children entering school only 50 percent were in a 
normal condition of health; in 1901-1902, 64 percent 
of the 833 entrants were below par. Formerly in 
Dresden when it was the custom to ascertain the state 
of the pupil's health from the parents, only 16 per- 
cent of children entering school were found to be sickly, 
but since the time of medical inspection the per- 
centage has risen enormously; for instance, in 1901 
in the third Dresden school district of the 664 children 
examined 44.27 percent were found sickly; and in 



SCHOOL DISEASES 159 

1902, of the 479 children entering school 79.01 per- 
cent were pronounced subnormal. These higher per- 
centages are due to the more thorough examina- 
tions; the findings emphasize the need of preventive 
measures to conserve the health of children. Medical 
examination reveals the fact that many children are 
physically unfitted for the work of the schoolroom. 
When in 1900 the first examinations were made in a 
number of Berlin schools, fully 300 out of the 2,500 
childn^n were found unfit for school. Most of the 
i-ejected children were in a state of general weakness 
after recovery from a severe illness such as scarlet 
fever; or they were suffering from rachitis or anemia — 
that is, physical conditions to be determined only by 
a physician. 

The School Physician. — It is evident from the fore- 
going discussi(Hi that the work of the school physician 
is to be advocated in the interests of the pu})lic, as 
well as in those of the family. It is the acknowledged 
aim of teachers and school officials to make the edu- 
cation of children a wholesome process, but unfortu- 
nately school men sometimes fail to realize this ideal 
in individual cases. This statement, which is ])ased 
on personal experience and a study of extensive 
literature, is made with certain demands in mind, 
demands which the school, embodying the idea of an 
institution for compulsory education, has naturally 
come to impose upon children. The lack here is not 
of good intentions on the part of school men, but 
rather of clear insight which neglects to make use of 
many possible preventive and constructive measures 
in the school. A long-continued study made of the 



160 SCHOOL HYGIENE 

legislative enactments in force in various civilized 
countries, so far as these enactments concern school 
hygiene, reveals a deplorable lack of properly directed 
effort toward hygienic ideals, even in cases where an 
excellent model is at hand and finances need not be 
considered. * An improvement may be hoped for only 
with the help of expert assistance, as has been demon- 
strated in those countries where progress has been 
made. Excellent work has of late been done in some 
of the German states, especially in the smaller ones. 

The demand for the school physician is not new; 
the need was felt more than a century ago, and during 
the past fifty years it has become imperative. Pre- 
vious to that time sanitation had been generally in 
charge of public health officers, with unsatisfactory 
results. In no country has there been so much dis- 
cussion and controversy about the school physician 
as in Germany. It would hardly be of interest to 
elaborate the details of this discussion at congresses, 
in pedagogical and medical circles and in the press of 
these professions, but it maybe useful to sum up briefly 
the imagined dangers of the school physician prob- 
lem. Teachers feared above all that the school phy- 
sician in the role of a new kind of inspector would cur- 
tail their limited freedom of action, and that he would 
make offensive censures. As a matter of fact, such 
has not been the experience in countries where the 
work of the school physician has been observed nor 
has it proved to be the case in Germany. 

School physicians are now employed in hundreds 
of cities in Europe and there has been no evidence 
that these fears were justified; very few complaints 



SCHOOL DISEASES 161 

have appeared in the educational, medical, or general 
press. Conflicts are possible wherever human beings 
congregate, and conflicts between the teacher and the 
school physician may not be entirely avoided in the 
future, ])ut experience has proved this much, that the 
medical inspection of school children by trained 
physicians is eminently desirable "and that the objec- 
tions against this system are largely figments of the 
imagination. 

It might have been expected that objection to the 
school physician would be based on another argument, 
that of increased work for the teacher, and as a matter 
of fact, the introduction of new provisions such as 
school baths and games has thrown an additional bur- 
den upon the instructor, not only in keeping records 
of these activities, ])ut in actual physical effort, as the 
weighing and measuring of children, and testing their 
vision and hearing. In Switzerland and in some parts 
of the United States teachers are required to assume 
these duties. In some cases of this kind it would 
seem to be only fair to make some financial return for 
the extra services demanded of the teacher. 

In the elementary schools of to-da}" there is little 
protest against the school phj^sician but this cannot be 
said of the higher institutions, although, according to 
Griesbach, many of the secondary schools in Germany 
have recently expressed themselves in favor of medical 
inspection, and a numl^er of eminent educators, Dorr, 
M. Hartmann, Herberich, Harn, Schiller, and Schot- 
ten have used their influence in this direction. But at 
all events, the situation in the secondary schools with 
rospect to medical inspection has not progressed to 



162 SCHOOL HYGIENE 

anything like the same extent as in the elementary 
schools. The reason seems to lie in a fear that the 
curriculum will be disturbed and the demands now 
made upon pupils will be criticised unfavorably. 
It is possible that this fear is justifiable, but it 
should be impressed upon the high schools that 
it is the first obligation of the school so to arrange its 
educational plans that there shall be no transgression 
of the laws of health, and the high school teacher 
should be made to see that it is desirable to cultivate 
an ideal of good health, which should lead him to seek, 
rather than oppose, the cooperation of the school 
physician. As to the limitation of the teacher's 
authority, that must rest with the school board. 
In Sachsen-Meiningen, Hungary and Saxony, where 
school physicians are employed at all the higher insti- 
tutions of learning, the plan has worked out, it seems, 
with practically no friction. Undoubtedly, the intro- 
duction of medical inspection into high schools will 
yield a mass of observations and experiences which will 
be of the greatest possible help for school boards 
to formulate plans for a more hygienic system of edu- 
cation. 

School conditions in the higher institutions may be 
regarded as more favorable than in elementary schools. 
The material in high schools is less heterogeneous, 
being the result, more or less, of a process of selection; 
but it is also true that large percentages of even these 
selected children have received no systematic medical 
examination. The argument of frequency of nervous 
disorders in the higher grades of the high schools has 
already been mentioned. What is most needed is 



SCHOOL DISEASES 163 

a clearer understanding of health conditions among 
young people, and this can be gained only with 
the assistance of the school physician. This is so 
significant that it seems hardly possible that the 
school teachers, men and women of culture, will 
seriously continue to oppose an ''innovation" which 
promises at least to afford real insight into present 
conditions, and holds out a hope that these may be 
improved with added knowledge. So far as the prob- 
lems of the school building — location and equipment 
are concerned — we already have at hand a mass of 
investigations made both by physicians and instructors. 
That in this direction also there is great room for im- 
provement is revealed by a personal study made of all 
the higher schools in a whole state. In consequence 
of such surveys of school buildings and equipment, it 
is possible to make suggestions for improvement. If 
school physicians do lack technical knowledge of 
hygienic school equipment and knowledge of the 
hj'giene of instruction that is not to be held to their 
discredit, as they have not been especially prepared in 
this branch. Their most important work, the diagno- 
sis of diseases or defects among children, would be 
rendered still more significant if the phj'sicians' train- 
ing had been especially directed to making examina- 
tions of eyes, ears, nose and throat; or better still if 
specialists in each of these branches could be employed, 
as is already the practice in some countries. 

Another obstacle which has made the solution of the 
problem difficult has come from members of the medi- 
cal profession itself who have feared conflicts between 
school • physicians and public health officers, and 



164 SCHOOL HYGIENE 

between school physicians and parents. It has been 
the fear of the family physician that the work of the 
medical inspector in the school would interfere with 
and limit his own practice. As a matter of fact, these 
fears also seem to be unfounded, for we hear of few 
conflicts between school physicians and general 
practitioners. So far as the relations of the school 
physician and the health officer are concerned, the cus- 
tom in Germany is that the city appoints the school 
physicians, who are also allowed to augment their 
income by private practice. With a clear understand- 
ing of the division of work, friction is not likely to 
arise. Of course, a more desirable plan, and one which 
the author advocated years ago, would be to select 
from a large number of such school physicians those 
who are especially efficient and are interesting them- 
selves in the school work, and provide them with a 
salary sufficiently remunerative to enable them to dis- 
continue their private practice. Under these circum- 
stances the school physician would be able to specialize 
on his work to an extent which is impossible to a prac- 
tising physician. At present, there is small incentive 
to a physician to devote himself intensively to the 
school work which is usually dropped as his practice 
increases. It must be remembered that generally 
really efficient service can be secured only when an 
adequate salary, with a prospect of advancement, can 
be offered as an inducement. For larger cities it 
would seem to be most practicable first to increase the 
number of public health officers who are in charge of 
the school work in the various districts; next to make 
a selection of such as are especially fitted for the 



SCHOOL DISEASES 165 

work of medical inspection in the schools; and then to 
afford the latter opportunity for further study in 
this field. 

Conflicts with the home are possible, for instance, 
when a spoiled child who simulates illness is found to 
be normal by the school physician; or there may be 
critical situations in the case of young girls who refuse 
to be examined by a young physician even in the pres- 
ence of a woman teacher. Such cases, however, con- 
stitute but a small fraction of the total school popula- 
tion. The difficulty in the latter instance might be 
overcome by the appointment of a num])er of women 
doctors, as is the custom in some countries. In gen- 
eral, the procedure in dealing with parents is to advise 
them what needs to be done for the child, so that where 
the parents can afford it they may consult their own 
family physician. The result will be that the family 
physician is consulted more and not less frequently. 
Indigent parents should be referred to a proper 
clinic or dispensary. Unfortunately, experience every- 
where shows that where the parents have been notified 
only a very small percentage of children receive treat- 
ment, partly because the parents are negligent though 
they may be quite able to pay for consultation, and 
partly because for those who can not pay there are not 
enough clinics and dispensaries. It may also be that 
the mother cannot spare the time to go far to a dis- 
pensary and cannot wait long after she gets there. 

School Nurses. — For these reasons, the service of a 
school nurse is of the greatest significance. The school 
nurse was first employed in London in 1901; the exam- 
ple thus set has been followed extensively in Great 



166 SCHOOL HYGIENE 

Britain and the United States, and the custom is 
spreading also slowly in Germany and Switzerland. 
These nurses go into the homes and confer with the 
mother, showing her how to rid the child of pediculo- 
sis, how to syringe the ear in case of a discharging dis- 
ease, etc.", the nurse also takes children to the dispen- 
saries. In short, she sees to it that the treatment 
recommended by the school physician is carried out, 
without cost to those who can not afford to pay, with 
cost to. those who are financially able. The school 
nurse marks a great advance in the work of medical 
inspection of school children. 

School Clinics. — Another mark of progress is the 
establishment of school clinics. This work, begun in 
1902 by Jessen in Strassburg (Germany) in the form of 
a dental clinic, has since then spread over all the civil- 
ized world so that clinics now exist in many cities. 
All children are examined and those who cannot pay 
have their teeth attended to free of charge, or they pay 
a nominal sum, while the parents who are able to pay 
for treatment are advised to do so. 

Different cities have general school clinics where 
treatment is given and slight operations are performed. 
The problem of free medical treatment of the poor in 
all advanced countries is recognized as an important 
question; it is most complex, but its solution can no 
longer be ignored. It is a well-known and sad fact that 
often those who cannot afford to pay will not go to the 
clinics — simply because the service there is charity. 
What is needed also is a deeper feeling of responsibility 
on the part of the parents, and laws forcing parents to 
secure treatment. 



SCHOOL DISEASES 167 

The indications arc that medial inspection of schools 
and school children will eventually be introduced into 
all classes of schools in all civilized countries, though 
not with equal rapidity in all, and that the country 
which introduces it earlier will reap the benefit earlier, 
as is the experience in all other cultural movements. 
Medical inspection exists to-day to a greater or less 
extent in all civilized countries, although in none of the 
greater European continental states has the problem 
been adequately solved for the public schools. Prog- 
ress has been made in some countries, the attempt at 
meeting the difficulties by state law in other countries 
has been a failure, while still others have made no 
serious attempt to solve the problem. The greatest 
difficulty of all is presented by rural communities. 

Historical Survey of Medical Inspection. — Belgium 
stands to the fore, not only alphabetically, but as the 
country which first adopted a system of medical 
inspection in its schools. School physicians have 
been appointed in Brussels since 1874, and the exam- 
ple has been followed by other Belgium cities. Many 
features of the old Brussels system have served as a 
model. A specialty of the Brussels system is that the 
school physician shall prescribe tonics, codliver oil or 
iron, to those children who may be in need of these 
helps, and that the medicine is to be taken regularly in 
school under supervision of the teacher. As far as we 
know, only one other city in another country, St. 
Petersburg in Russia, has adopted a similar rule. 
The school records show that about 10 percent of the 
children in the schools of Belgium every year are in 
need of this preventive treatment, and that the results 



168 SCHOOL HYGIENE 

have proved most satisfactory. Belgium also has 
good school clinics. 

In Germany, Saxony has taken the lead since 1892, 
when 15 school physicians wej-e appointed in the city 
of Leipsic. Conditions in Germany differ very much 
in the different states. The work has been well 
summarized by Schubert in his book on medical 
inspection in German schools, though much has been 
done since then. According to Schubert, Sachsen- 
Meiningen has the greatest number of school physi- 
cians. As a result of the untiring effort of Leubuscher, 
school nurses have been installed, medical inspection 
has been introduced also into the higher schools, and 
a beginning is being made in the country districts. 

The system of medical inspection established in 
1896 in the city of Wiesbaden deserves particular 
attention; it has served as a model for many cities 
introducing medical inspection, and many others have 
already modified their plans in conformity with its 
provisions. In Wiesbaden the parents of school 
children are informed by circular about the aims of the 
system. The beginners, after they have presented a 
certificate from their family physician, undergo a 
first, rather rapid examination by the school physician 
with respect to contagious diseases and vermin. Later 
on, in the course of the first month, they are examined 
with greater care to ascertain whether regular medical 
supervision or special concessions in their school work 
may be necessary. The mother is invited to be pres- 
ent at this examination. The results are embodied 
in a health report which is filed in the school and which 
when the child leaves is sent to the other school that 



SCHOOL DISEASES 169 

he enters. The report of every child who needs medical 
supervision bears the words ''medical control." The 
child is re-examined in the third, fifth and eighth year 
of school life. After the last examination, as it may 
seem desira})le, the parents are ur^ed to consult with 
their physician before deciding upon a calling for the 
child. 

The school physician has office hours in the school 
building every two weeks, more frequently in the case 
of contagious diseases. On the day preceding the 
visit of the school physician, a circular is sent to the 
various classrooms, on which the different teachers 
mark the names of those ''medical control" children 
who are to be examined. The classroom teachers then 
submit the health reports of such pupils to thW school 
physician. The physician spends the first half of his 
time visiting the classrooms, so that each room is 
examined at least twice during the term as to heating, 
ventilation, seating, etc. The second half of the time 
he spends in interviewing, in a private room, the 
children whose names he has on his list. The sick 
ones he recommends to the care of the family physician 
or to a clinic; the small children carry a note home 
explaining their condition. To ascertain whether 
absences from school are justifiable, the school physi- 
cian may have to visit a number of children in their 
homes if he is so directed by the principal. The school 
physician is not permitted to give directions to the 
personnel of the school, but he has the right in case his 
suggestions are disregarded to complain to the com- 
mission on school hygiene; in urgent cases he can 
report to the superintendent of schools or the health 



170 SCHOOL HYGIENE 

officer. He enters his remarks about sanitary and 
hygienic conditions of the schoolroom in the hygiene 
book kept in the. school and makes regular reports to 
his chief, who includes them with others in his own 
report to the city authorities. The school physicians 
hold general conferences to which the local health 
officer is invited when matters of sanitation are under 
discussion. Resignations are adopted at three months' 
notice, but if a school physician neglects his duty he 
may be dismissed without further ceremony. Ger- 
many has many variations of the Wiesbaden plan, 
but the matter of treatment everywhere still needs 
improvement. Mention must be made in this con- 
nection of the work done in Berlin to extirpate a 
certain tenacious hair disease which is relatively rare 
in Germany but very contagious. About 100,000 
children were examined and the few whose hair really 
was diseased were cured — at an expenditure of enor- 
mous sums of money, which might be considered small 
in comparison to the cost of extirpation if the disease 
had spread, but which under the particular circum- 
stances seems high. 

England and Wales are establishing medical in- 
spection of schools through the state — a great step in 
the advance of progress. The Education (Adminis- 
trative Provisions) Bill places the duty of providing 
for the medical inspection of school children, as well 
as the power to make other arrangements for the 
health and physical welfare of children, upon the local 
authorities. The state contributes annually a certain 
amount per capita attendance (a matter of about 
$70,000,000), and each community has not only a 



SCHOOL DISEASES 171 

material interest in good school attendance but desires 
to meet the state requirements, because in cases of 
negligence the state contribution can be withdrawn. 
This places a valuable weapon in the hands of the state 
authorities in enforcing medical inspection of schools. 
In 1908-1909, 314 of the 328 school districts had school 
physicians and 55 had already provided for the treat- 
ment of children; in 1909-1910 there were in 152 such 
districts school nurses. Admirable work has been 
done in some rural communities, and as a state system 
of medical inspection the Enghsh procedure takes 
first rank. Comparable to English progress in these 
matters is that made during the past few years in 
certain states of the United States where legislative 
enactments on the subject have been passed. ^ 

In Austria in 1909 medical inspection was extended 
to the state normal schools. In this way the pros- 
pective teachers become thoroughly familiar with 
the workings of a system of medical inspection 
before tliey enter their profession. The very suc- 
cess of these future propagandists will depend very 
much upon the way in which medical inspection is 
carried on in the normal schools. As early as 1885 
the appointment of school physicians by the state 
was begun in the higher schools of Hungary. These 
physicians nmst present evidence to show that they 
have been trained for the work. Their duties include 
sanitary inspection of the school building as well as 
the examination of school children. The curriculum 
of the last two years of school includes facultative 
instruction in hygiene. 

Our historical survey closes with Japan where 



172 SCHOOL HYGIENE 

medical inspection has been prescribed by law since 
1898, and where it may be suspended only at the dis- 
cretion of the governor in communities numbering 
less than 5,000 inhabitants. In 1909 the number of 
active school physicians numbered 6,975, and these 
men covered only about 54 percent of all public 
schools. The outlay for medical inspection in the 
schools of Japan seems exceedingly small, while the 
number of school physicians is an imposing one; but 
unfortunately exact information is lacking on the most 
important point — the actual benefit derived therefrom 
by the individual child. 



HYGIENE OF THE TEACHING PROFESSION 

The hygiene of the teaching profession can be treated 
only very generally because it must cover many differ- 
ent conditions and different kinds of schools. The 
profession of the teacher means taxing work, which 
differs for instance from the work in an office by the 
intensive application, which can not always be spon- 
taneous, demanded at every minute of the teaching 
day. This intensity has moreover been further 
deepened by the new methods of teaching. To ipeak 
continuously in a large room, supervising at the same 
time a great number of children and holding the 
attention of every individual child, to deny oneself 
needed pauses for rest, to repress natural needs, all 
this means an enormous strain on the nervous system 
in general, with particular emphasis upon certain 
organs, those of the throat, for instance, all of which, 
as every teacher knows, is exhausting. The constant 
demand made upon the eyes and ears in the constantly 
interrupted attempt to stimulate thought processes of 
large numbers of individuals, whether instruction or 
examination be in progress, requires a supply of energy 
which can hardly be appreciated by the layman. 
Teaching in a schoolroom is very different from giving 
a private lesson to a single pupil, so far as the energy 
output of the teacher is concerned. 

173 



174 SCHOOL HYGIENE 

And the duties of the teacher are not ended when 
school is over. The written work of the children 
must be corrected, which in the case of large classes 
and difficult subjects may become an instrument of 
mental torture for the teacher. In this way the 
teacher may get into a condition of overwork which 
can not fail to be injurious to health.* Because of the 
disadvantageous circumstances under which many 
teachers must work, it is not surprising that many fall 
victims to chronic nervous excitability and chronic 
disturbances of the organs of speech. The degree to 
which nervous excitability may go is demonstrated by 
the excitement caused among the teaching profession 
in Germany by the discussion of the Liability Act in 
regard to accidents of pupils. Women teachers espe- 
cially should be shielded from overwork. Persons of 
delicate health, those having a nervous tendency, or 
those afflicted with serious defects, should not choose 
teaching as a profession. A sound constitution, ability 
to endure, patience, poise and a happy spirit are in- 
valuable assets of persons who intend to take up a 
teacher's career. 

Finally, it must be emphasized that the work of the 
school physician should be directed also to obtaining 
a clearer understanding of what is needed to insure 
hygienic conditions for teachers. It is not yet the 
function of the school physician to make routine ex- 
aminations as to the state of health of instructors, but 
it is surely not too much to ask that the physician 

* For a detailed discussion of the hygiene of the teaching profes- 
sion the reader is referred to pages 374-385 of the larger work, 
'Handbuch der Schulhygiene." 



HYGIENE OF TEACHING PROFESSION 175 

shall report unhygienic conditions wherever he finds 
them in the school and that if teachers desire to 
consult him about school work or wish advice about 
equipment, he should be willing to give his services. 
By following a course thus outlined it will be possi- 
ble to obtain accurate data as to what is needed to 
raise the health and vigor of the teaching profession to 
a higher level. 



BIBLIOGRAPHY 



It has not been possible in the small compass of this 
volume to present more than a cursory discussion. 
Those who may desire more detailed and ('oi#i)rehen- 
sive data on the various subjects included under the 
term school hygiene are referred to th(» larger work on 
the subject, "Handbuch der Schulhygiene,"* which 
contains in addition to extensive discussions and 
excerpts from original studies, a very large and care- 
fully compiled bililiography. In addition a very small 
number of new works may be of help. Arranged 
under the various headings they are: 

The Schooliiouse and its Equipment 

HiNTRAGER, K., " Volksschulhauser in Schweden, Norvvegen, 
Danemark und Finnland," 2nd edition. J. M. Gebhardt, 
Leipsic, 1914. " Volksschulen in Oesterreich-Ungarn, 
Bosnien und Herzegowina." Bergstrasser (Kroner) 
Stuttgart, 1901. " Volksschulen in Frankreich." Ebenda, 
1904. The above works may be found in the series en- 
titled, ''Fortschritte auf dem Gebiete der Architektur," 

*BuRGERSTEiN, L. and Netolitzky, a. "Handbuch der Schul- 
hygienc," 3rd edition. Joh. Anibr. Barth, Leipsic, 1912 



176 BIBLIOGRAPHY 

published by Bergstrasser in Stuttgart. In addition to an 
account of the laws and provisions which have been 
passed, these works contain a complete bibliography. 
Much of this is applicable to high schools also. 

The Hygiene of Instruction 

Offner, M., "Mental fatigue. A comprehensive exposition 
of the nature of mental fatigue, of the methods of its 
measurements and of their results with special reference 
to the problems of instruction." Translated from the Ger- 
man by Guy Montrose Whipple, assistant professor of 
educational psychology, Cornell University. Baltimore. 
Warwick & York, 1911. (With bibliography.) 

Physical Training 

Schmidt, F. A., "Unser Korper. Handbuch der Anatomic, 
Physiologic u. Hygiene der Leibesubungen," 4th edition. 
Voigtlander, Leipsic, 1913. 

Medical Inspection of Schools 

Schubert, P., "Das Schularztwesen in Deutschland." Voss, 
Hamburg, 1905. A number of the books published 
by G. B. Teubner, Leipsic, in the series "Aus Natur und 
Geisteswelt" will be of interest, particularly those on 
anthropology, medical treatment, and hygiene. The 
original of the translation of the present little book is 
volume 36 of that collection. 

GuLiCK, Luther H. and Ayres, Leonard P., "Medical In- 
spection of Schools," 2nd edition, Survey Associates, New 
York, 1913. 



INDEX 



Abersee, Lake, vacation camp 
on, 140. 

Adjustable furniture, discus- 
sion of, 49, 50. 

iEstheometric method of 
measuring fatigue, 78. 

Agahd, industrial work of 
cliiklrcn studied })y, 123. 

Age, for entering scliool, SI. 

Air: condition of, during 
singing, 122; (k^terioration 
of, during k^sson period, 9(); 
discussion of, 29-32; kept 
good by garden, 63. 

Airing: importance of, 33, 34; 
necessity for, at end of les- 
son period, 96. 

Albumin, in urine, in children 
using curved hack rest, 53. 

Alcolu)!: in boarding scliools, 
143; in camps, 141; discus- 
sion of, 150. 

Alcohol lami)s, unsuitability 
of, for school, 27. 

Alphaljet measure, by Cohn, 
107. 

Alsace-Lorraine, law in, re- 
garding size of classes, 90. 

Aml)idexterity, futility of 
training for, 118. 

Ana?mia, among secondary 
school children, 84, 85. 

Antiseptic blackboards, used 
in New York City, 59. 

Arrangement of rooms in the 
schoolhouse, 15. 

Arithmetic, Friedrich's tests 
of, after or without recesses, 
100. 

Assembly room (see Recrea- 
tion Hall). 



Asthenopia, due to eyestrain, 
116. 

Attention, period of possible, 
94, 95. 

Austria, law in: about exami- 
nations, 128; concerning 
order of subjects in curricu- 
lum, 101 ; regarding corporal 
punishment, 134; regarding 
weight of school books, 94. 

Austria, medical inspection of 
schools in, 171. 

Bacteria, moist floors breeds 
45. 

Back rest, of seat, SB. 

Badalini, investigation by, 
concerning effect of posture 
on respiration, 110. 

Barracks, school, temporary 
use of, 4. 

Basel, rules regarding text- 
book print in, 108. 

Baths: deprivation of, as pun- 
ishment, 136; discussion of, 
63-65. 

Belgium : corporal punish- 
ment in, 134; first to 
have medical inspection of 
schools, 167. 

Bergen, average attendance 
per class in, 90. 

Berger, statement by, concern- 
ing nearsightedness, 157. 

Berlin: hair, disease in, 170; 
half-hour lessons in, 96; sub- 
normal children entering 
school in, 159; time spent on 
music in, 127. 

Berne, abolishing of slates in, 
109. 



177 



178 



INDEX 



Beutner, pavilion school built 
by, 5. 

Binet, physical effect of exam- 
inations studied by, 129. 

Bion, originator of the vaca- 
tion colony, 140. 

Blackboards, discussion of, 59. 

Boarding schools, discussion 
of, 142, 143. 

Bonoff, physical effect of ex- 
aminations studied by, 129. 

Books: carrying of, 92-94 
print in, 107; weight of, 93 

Boys : industrial work of, 127 
suicides of, 135. 

Brillengeradehalter, descrip- 
tion of, 58. 

Brussels, school physicians 
first appointed in, 167. 

Camps, discussion of, 140, 141. 

Carbon dioxide, percentage of, 
in fresh and in expired air, 29. 

Casein cement, description of, 
44. 

Ceiling of the classroom, 44. 

Cellar, desirability of a, 11. 

Cesspools, discussion of, 70. 

Charlottenburg, open air 
school in, 141. 

Children, care of, v, xv. 

Chimneys, special, for gas 
heating, 39. 

Chlopin : nervous disorders 
among high school children 
investigated by, 131; sui- 
cides in high schools studied 
by, 135. 

Chlorosis, in high school chil- 
dren, 84. 

Christiania, average attend- 
ance per class ih, 90. 

Classroom: discussion of, 42; 
importance of the, 15, 18; 
location of, 16, 18. 

Cleaning: discussion of, 73, 
74; of windows, 24; of 
shades, 25. 



Clinics, school, discussion of, 
166. 

Cloak rooms: discussion of 
12, 13; for gymnasium, 61; 
in London schools, 13, 16; 
separate, in Danish school- 
house, 16. 

Closets: outdoor, in Maine 
schools, 71; siphon, 69. 

Co-education, discussion of, 
82-88. 

Cohn: examination by, con- 
cerning nearsightedness, 
156; on lighting, 18; rules 
by, regarding print, 106. 

Constitution, of children, 78. 

Construction, of the school- 
house, 2, 11, 12. 

Contagious diseases, spread 
of: in boarding schools, 142; 
by drinking cup, 10; in 
large classes, 89. 

Contagious diseases, discus- 
sion of, 154-156. 

Cooking, instruction in, 66. 

Copenhagen: law in, against 
dust, 74; vacation camps 
started in, 140. 

Copybook: guide for, 115; 
position of, 112. 

Corners, need of rounded, 
44. 

Corporal punishment, discus- 
sion of, 133-135. 

Corpuscle, red blood, effect of 
bad air on, 32. 

Corridors: location of, 16; 
width of, 14. 

Cottage plan of school, 4. 

Curriculum, of secondary 
schools, 87-103. 

Cuspidors, for the classroom, 
59. 

Danish Commission: illness in 
secondary schools investi- 
gated by, 83; report on 
desks by, 49. 



INDEX 



179 



Danish schoolhouse, plan of a, 
13, 16. 

Dankwarth, experiments by, 
on airing, 34. 

Deaf children, special provi- 
sion for, 51. 

Defective children, discussion 
of, 79-81. 

Denmark: law in, concerning 
size of classes, 90; one- 
roomed schoolhouse of, 16; 
one-session scho(jl da}' in, 
105. 

Dental clinics, in Strassburg 
and elsewhere, 166. 

Desks: discussion of, 46-57; 
two-seated, 56. 

Dettweiler, saliva ci'p de- 
signed by, 59. 

Diagnosis of disease, by scliool 
physician, 163. 

Dictation, Fried rich's tests of, 
after or without recesses, 

lo;). 

Dimensions of schoolroom, 42, 
89. 

Disinfecting of walls, 44. 

Distance: adjusters, 54; be- 
tween seat and desk top, 
53. 

Docrnlierger, studies by, re- 
garding overwork, 126. 

Domestic science, rooms for, 
66, 116. 

Dormitories, in boarding 
schools, 143. 

Dorr, medical inspection ad- 
vocated by, 161 

Dresden, subnormal chiklren 
entering school in, 158. 

Drinking cups: in common 
use, 9, 10; disease spread 
by, 154. 

Drontheim : average attend- 
ance per class in, 90; 
pavilion school at, 5, 6. 

Dufestel, measuring rod de- 
signed by, 48. 



Dust: burned, a cause of air 
deterioration, 37, 40; har- 
bored by soft wood floors, 
44; in the gynmasium, 60; 
oiling of floors recommend- 
ed for, 45; particularly in- 
jurious during singing, 122; 
presence of, on light reflect- 
ors, 26; problem most fre- 
quently studied in schools, 
33; source of air deteriora- 
tion, 32; stirred up by 
cleaning, 74. 

Dusting, of furniture, 33. 

Dwelling, and school com- 
bined, 72, 73. 

Dynamometer, for estimating 
fatigue, 77. 

Egloff, Welsbach lamp de- 
signed by, 27. 

Eichstadt, instruction in hy- 
giene first given m schools 
of, 149. 

Electric light, best for schools, 
26. 

^*]lementary schools: home- 
work in, 123; hygiene in- 
struction in, 148; sex in- 
struction in, 153. 

England (see also Great Bri- 
tain) : law in, regarding in- 
struction in cooking, 66; 
medical inspectioi;i in, 170. 

P^ntrance to schoolhouse, 12. 

Ercklentz, experiments by, on 
air condition, 31. 

Ergograph, fatigue tests by 
the, 77, 120, 121. 

Erismann, quoted on light, 26. 

Esmarch, von, air deteriora- 
tion through burning dust 
found by, 37. 

Eulenberg, investigation by: 
concerning suicides, 135; 
regarding spinal curvature, 
84; regarding weight of 
school books, 93. 



180 



INDEX 



Examinations, discussion of, 
127,128. 

Excursions, on holidays, 141. 

Exercise: during penmanship 
period, 111; gymnastic, dis- 
cussion of, 118; need of rest 
after, 98, 122; physical, in 
New York City schools, 96; 
small opportunity for, 105. 

Expectoration receptacles, for 
the schoolroom, 59. 

Extra lessons, time devoted 
to, 126, 127. 

Eyes, strain upon, in hand- 
work, 116. 

Eye shields, necessary with 
direct light, 29. 

Fatigue: discussion of, 75-78; 

produced by different school 

subjects, 101; produced by 

play, 119, 120. 
Feeding of school children, 66, 

67. 
Filtering of dusty air, 36. 
Filters, unreliability of, 8. 
Finland: co-education in, 88; 

corporal punishment in, 134. 
Fire regulations, discussion of, 

74. 
Floors: covering for, in gym- 
nasium, 60; discussion of, 

44-46. 
Flligge, experiments by, on 

ventilation, 30. 
Forster, cooking instruction 

advocated by, 66. 
Fountains, drinking, discus- 
sion of, 9-11. 
France, corporal punishment 

in, 134. 
Frank, modern school hygiene 

introduced by, xvii. 
Frankfort, plan of schoolhouse 

of thirty-two classes in, 15, 

16. 
Friedrich, effect of recesses on 

work, investigated by, 99. 



Fungus, on the walls, 12. 
Furttenbach, on schoolhouse 
and equipment, xv. 

Gardens, for the school, 63. 

Gas: heating by, 38; lighting 
by, 26. 

General practitioners, in rela- 
tion to school physicians, 
164. 

Germany, adjustable desks 
used in, 49. 

Giessen, one-session school 
day in, 105. 

Girls: co-educative competi- 
tion in high schools harmful 
to, 85; greater suggestibility 
of, 86; greater tendency to 
eyestrain of, 116; individual 
exercise curriculum needed 
for, 120; mentality of, equal 
to boys, 86; music lessons 
of, 127; spinal curvature 
among, 92, 158. 

Glue, unhygienic conditions 
caused by, 117. 

Gossler, von: decree on play 
by, 63; statement by, on 
homework, 124. 

Gottingen, school baths first 
used in, 63. 

Grassmann, studies by, con- 
cerning overwork, 126. 

Great Britain (see also Eng- 
land) : adjustable desks in, 
49; medical inspection in, 
170; school nurses in, 166. 

Griesbach, method of, for 
measuring fatigue, 78. 

Grimm, statement by, con- 
cerning use of Latin type, 
109 

Grollmuss, device by, for 
copybook writing, 115. 

Groupe scolaire, at Viroflay, 
France, 17. 

Gstettner, statement by, 
concerning blackboards, 59. 



INDEX 



181 



Gymnasium, discussion of, 60, 
61. 

Gymnastics (see also Exer- 
cise): discussion of, 118. 

Hakonson-Hansen, pavilion 
school designed by, 5, 6. 

Halle : investij^jation concern- 
iny^ illness of school children 
in, 103; investigation con- 
cerning sleep of children in, 
130. 

Hansen, adjustable desk, 49. 

Harn, medical inspection ad- 
vocated by, 161. 

Hartman, medical inspeclion 
advocated by, Kil 

Headache, in secondary school 
children, S.'). 

Health otticers, in relation to 
school physicians, 164. 

Hearing, tests for, by teach- 
ers, 161. 

Heat: accumidation of, in 
body, .30, 31; loss of, by 
airing, 34. 

Heating, discussion of, 36- 
41. 

Helsingfors, first city to give 
sex instruction to elemen- 
tary school graduates, 152. 

Hclwig, effect of bad air on 
red blood cells studied bv, 
32. 

llcrl)erich, medical inspection 
advocated by, 161. 

Hertel, investigation by, con- 
cerning illness of school 
children, 81, 83. 

Hessen: corporal punishment 
in, 134; forty-five minute 
lessons in, 96; homework in, 
124; one-session school day 
in, 105. 

High schools (see Secondary 
Schools). 

Historical survey, of medical 
inspection, 167. 



Homecraft schools, in London, 

66. 
Homework, discussion of, 123. 
Hot air heating, discussion of, 

40. 
Hot water heating, discussion 

of, 40. 
Hours, discussion of, 91, 92. 
Humidity, high, favorable to 

heat accumulation, 31. 
Hungary: medical inspection 

in normal schools of, 171; 

school physicians in high 

schools of, 162. 

Iberg, designer of Brillen- 
gcradchalter, 58. 

Ice fields, in small towns, 62. 

IgnatiefT, physical etTect of 
examinations studied by, 
129. 

Infections (see Con%,gious dis- 
eases). 

Inspection, for personal clean- 
liness, 94. 

Instruction: in hygiene, 145; 
length of, period, 94. 

Insulating material, in build- 
ing, 11. 

Iwliew, physical effect of 
examinations studied by, 
129. 

Janitor, desirability of, liv- 
ing in schoolhouse, 73. 

Japan: corporal punishment 
in, 134; decree of, regarding 
recreation, 97; medical in- 
spection in, 171. 

Jasper, diffused lighting first 
used by, 27. 

Jessen, in charge of first 
dental clinic, 166. 

Kalle, instruction in cooking 

advocated by, 66. 
Kamp, instruction in cooking 

advocated by, 66. 



182 



INDEX 



Keller: fatigue produced by 
gymnastics tested by, 120; 
use of 45-minute lesson, 
periods by, 96. 

Kenotoxin: antibody for, 76; 
experiments with, by Wei- 
chardt, 75. 

Kerosene lamps, unsuitability 
of, for school, 27. 

Kertzsch, statement by, con- 
cerning nearsightedness, 
157. 

Key: investigation by, con- 
cerning sleep of high school 
pupils, 130; investigation 
by, concerning time spent 
on music, 127; investiga- 
tions by, regarding illness 
of secondary school chil- 
dren, 83, 131; study by, con- 
cerning effect of homework, 
125. 

Kindergarten, combined with 
elementary school, 18. 

Klagenfurt, abolishing of slates 
in, 110. 

Knapsack for carrying books, 
92. 

Kraepelin, statement by, re- 
garding inattention, 95. 

Lavatories: discussion of, 59; 
for gymnasium, 61; in Lon- 
don schools, 13. 

Length of instruction period, 
94. 

Lentz, suicide case cited by, 
135. 

Lessenich, physique of school 
children studied by, 79. 

Leubuscher: nervous disturb- 
ances in high schools in- 
vestigated by, 130; on in- 
dustrial work of children, 
124. 

Light (lighting), discussion of, 
19-29. 



Lindholm, investigation by, 
regarding anemia and head- 
ache in secondary schools, 
85. 

Linoleum, for the classroom, 
45. 

Lobsien: absence records stud- 
ied by, 139; effect of breath- 
ing exercises on mentality 
investigated by, 32. 

Location, of schoolhouse, 7. 

London : cloakrooms in schools 
of, 13; instruction in domes- 
tic science in, 66; number of 
children to a class in, 90; 
practice of leaving books in 
school in, 94; roof play- 
grounds in, 62; schoolhouse 
of twenty classes in, 14, 16; 
school nurses first employed 
in, 165; swimming pools in, 
65 ; tiling used in classrooms 
of, 44. 

Lorenz, use of anti-kenotoxin 
by, 76. 

Lorenz, H., designer of posture 
head band, 58. 

Lumbar spine, need of support 
for, 53. 

Maine, closets prescribed by 
board of health in, 71. 

Malnutrition, a cause of back- 
wardness, 79. 

Manual training, hygienic 
value of, 116. 

Maps, need for clearness of, 
108. 

Maxims, for hygiene instruc- 
tion, 148. 

Meals, disadvantageous ar- 
rangement of, 102, 105. 

Measuring: of children for 
desks, 47; rod, 48. 

Medical inspection of schools: 
for contagious diseases, 155; 
need of, 125. 



I 



INDEX 



183 



Meidinger stove, description 

of, 35, 36. 
Mental energy : diminished by 

physical exercises, 98; raised 

by recesses, 101. 
Mentality of girls, compared 

with that of l)oys, <S6. 
Mentally defective, not as 

robust as normal children, 

79. 
Meyer, quantity of dust in 

schoolroom f(jund by, 32. 
Mikkolson, studies by, con- 
cerning posture in manual 

work, 117. 
Mohaupt, use of talk periods 

by, 96. 
Moral delinquencies: not a 

great danger in coeduca- 
tion, 86; spread of, in large 

classes, 89. 
Morbidity, highest in March 

and April, 138. 
Mosso, inventor of ergograph, 

77. 
Movable desks, description 

of, 56, 57. 
Mimich : deprivation of l)atiis, 

punishment in, 136; feeding 

of school children in, 67. 
Muscle capacity, t-est of, for 

fatigue, 77. 
Music lessons, time spent on, 

127. 
Myopia (see Nearsightedness). 

Nearsightedness: discussion 
of, 156, 157; relief aiTorded 
to, by recesses, 97; special 
provision for, 51. 

New York City: gymnastic 
exercises in, 96; roof plaj'- 
grounds in, 62, Fig. 32. 

Nitrogen, per cent, of, in fresh 
and expired air, 29. 

Noise, prevention of, 11. 

Normal schools, medical in- 
spection in, 171. 



Northern exposure, value of, 
in comparison with south- 
ern, 7. 

Norway: law in, regarding 
size of classes, 90; pavilion 
schools in, 5, 6. 

Norwegian committee, inves- 
tigation by, regarding ill- 
ness of secondary school 
children, 83. 

Nund)er of pupils to a class, 88. 

Nurses, school, discussion of, 
165, 166. 

Nussbaum, deterioration of 
air through burning dust 
found by, 37. 

Oblique writing, discussion 
of, 111-116. 

Oil: for floors, 45, 60; for 
toilets, 69, 72. 

Oker-Blom: studie% bj', con- 
cerning fatigue, 120; work 
l)y, on sex instruction, 153. 

One- or two-session dav, dis- 
cussion of, 102-106. 

Open air l)oarding schools, 
origin of, 143. 

Open air .schools, discussion of, 
141. 

Overcrowded classes: a cause 
of overwork, 127; hygienic- 
ally considered, 89. 

Overwork: discussicni of, 130; 
of teachers, 174. 

Oxygen, per cent, of, in fresh 
and expired air, 29. 

Palmberg, excuses from phys- 
ical training investigated 
by, 85. 

Paper, surface of, for writing, 
110. 

Paris, provision for school 
feeding in, 66. 

Patzak, study by, 9n compre- 
hension by pupils of sub- 
jects taught, 126. 



184 



INDEX 



Paul, experiments by, on air 
condition, 31. 

Pavilion school at Drontheim, 
5, 34. 

Pedestal desk, illustration of. 
Fig. 27. 

Penholder, proper position of, 
111, 113. 

Pettenkofer, von, criterion by, 
for air condition, 30. 

Physical examination : for 
gymnasium work, 66, 120; 
necessary for camp life, 
140. 

Physical director, work of the, 
147. 

Physical training (see also 
Gymnastics) : excuses from, 
85; in the open preferable, 
61; medical examination 
necessary for, 120. 

Physician, school : aid to teach- 
ers afforded by the, 174; 
discussion of, 159-165; dis- 
missal of, 170; for hygiene 
instruction in secondary 
schools, 146; needed for ex- 
amination of children enter- 
ing school, 158; visits of, to 
homes, 169. 

Physics instructor, recom- 
mended for supervision of 
heating, 41. 

Physiological methods for 
measuring fatigue, 78. 

Piesen, injury caused by back 
rest found by, 53. 

Pirquet, von, on tuberculosis 
in children, 61. 

Planning: of gymnasium, 61; 
of schoolhouse, 1-2. 

Play: discussion of, 118-122; 
required amount of space 
for, 14, 62. 
Playgrounds : discussion of, 
61-63; indoor, 14; outdoor, 
covered, 18; supervision of, 
16. 



Pleasure, deprivation of, as 
punishment, 136. 

Pleier, camera for measuring 
angle of light, 20, 21. 

Photometer: by Weber, 19; 
by Wingen, 19. 

Pits, for waste, 70. 

Plans of schoolhouses, 16. 

Population, school: percent- 
age defective, 80; propor- 
tion to total, 4. 

Porter, physique of school 
children studied by, 79. 

Posture: bad, caused by near- 
sightedness, 157; bad print 
leads to bad, 107; discus- 
sion of, 58-59; effect of bad, 
on respiration, 110; in writ- 
ing, 108, 111; importance of, 
in manual work, 113, 117; 
not to be forced by desk, 46. 

Prausnitz, experiments with 
diffused lighting by, 28. 

Print, Cohn's rules for, 107. 

Progress in school, in relation 
to physique, 78. 

Prussia, law in, regarding 
length of lesson periods, 96, 
105; law in, regarding size of 
classes, 90; provision in, for 
leaving books in school, 94. 

Psychological methods, for es- 
timating fatigue, 77. 

Puberty, differences of devel- 
opment at, 82. 

Pubescence, period of lessened 
resistance, 87. 

Punishments, discussion of, 
131-135. 

Pupils, number of, to an av- 
erage room, 42, 89. 

Reading, discussion of, 106- 

109. 
Recess, discussion of, 96-101; 

necessity of, 67; not to be 

forfeited, 132; pedagogical 

value of the, 98. 



INDEX 



185 



Recreation (see also Play) : 
curtailed time for, 126; pro- 
vided for, by Japanese law, 
97. 

Recreation hall, for all classes, 
15; supervision of, 16. 

Reddie, originator of "The 
New School," 143. 

Reflectors, for windows, 25, 26. 

Reihmayr, experiments with 
direct lighting by, 29. 

Reifeprufungeriy hygienically 
considered, 128. 

Rettig, inventor of movable 
desk, 56. 

Roller, industrial work of boys 
studied by, 127. 

Rollers for desks, 56, 57^ Figs. 
30,. 31. 

Roof playgrounds, in New 
York City, 62, Fig. 32. 

Room angle of light, 20, 21. 

Rural: difficulty of medical 
inspection in, schools, 167; 
schools, 3; school, Danish, 
16; medical inspection in, 
English schools, 171; wells, 
8. 

Russia: nervous disturbances 
in high schools in, 131; va- 
cations in, 137. 

Sachsen-Meinigen, school 
physicians in high schools 
in,' 162. 

Saxony: law in, regarding 
higher education of girls, 
88; schools physicians in, 
162, 168. 

Scandinavia, co-education in, 
88. 

Schiller, medical inspection 
advocated by, 161. 

Schmid-Monnard: illness of 
children attending both 
school sessions, 103; in- 
crease in weight, 81; inves- 
tigations by, regarding 



physique of mentally defec- 
tive, 79; sleep of children 
in Halle, 130. 

Schmidt (Dresden), experi- 
ments by, on airing, 34. 

Schmidt, F. A.: physiological 
value of exercise studied by, 
118; physique of school 
children investigated by, 79. 

Schoolhouse: at Viroflay, 
France, 17; construction of, 
11; drying of, 12; for use of 
other than school purposes, 
73; location, with respect to 
compass of, 7; plans, 16-18; 
plan of Danisli, 13; plan of 
London, 14; plan of Frank- 
fort, 15; planning and erec- 
tion of, 1; rural, 3; site of, 2. 

Schotten, medical inspcc^tion 
advocated by, 161. 

Schubert: desk gui^ for writ- 
ing by, 115; on medical 
inspection, 168; rules by, 
concerning print, 107. 110. 

Schulthess, position of spine 
in sitting recommended by, 
53. 

Schuyten: measurement of 
fatigue by, 77; study by, 
regarding attention, 137. 

Scoliosis (see Spinal Curva- 
ture). 

Seat, of school desk, 51. 

Secondary schools: children 
of, a selected group, 79; 
coeducation in, 82; corporal 
punishment in, 135; curri- 
culum in, hygienically dis- 
cussed, 87-88; homework in, 
124; hygiene instruction in, 
149; medical inspection in, 
161; music lessons taken by 
students of, 127; nervous 
disturbances in, 131; sleep 
obtained by pupils in, 130; 
suicides in, 135; use of alco- 
hol by students of, 151. 



186 



INDEX 



Selter, quoted on absorption 
of light by window panes, 
24. 

Sewing, hygienic requirements 
for, 116. 

Sex hygiene, discussion of, 
152-153. 

Sexual irregularities : among 
unsupervised children after 
school, 132; due to reten- 
tion, 67; due to too long 
sitting, 97; in relation to 
corporal punishment, 133, 
134; rapid spread of, in 
boarding schools, 142. 

Shades: for direct lighting, 28; 
for windows, 25. 

Sickinger, care of subnormal 
children studied by, 81. 

Sickness: among pupils of the 
one- and the two-session 
day, 103; as an effect of 
too much homework, 125; 
greatest in March and April, 
138; of children in second- 
ary schools, 83, 131. 

Singing, hygienic significance 
of, 122. 

Sites: for schoolhouse, 2, 7; 
restriction of, 4. 

Sitting, unhygienic effect of 
long, 46. 

Slate, disadvantages of the, 
109. 

Sleep, need of sufficient, 91, 
130. 

Snyder, designer of roof play- 
ground, 62, Fig. 32. 

Special classes for defective 
children, 80, 81. 

Specialists, for eyes, ears, 
nose, and throat, 163. 

Spinal curvature: caused by 
carrying books, 92, Fig. 36; 
discussion of, 157, 158; per- 
centage among boys and 
girls in Berlin, 84. 



Stairways: fireproof, 12; sepa- 
rate for janitor, 18; width 
of, 15. 

Standing: fatigue caused by, 
122; not a good form of 
punishment, 132. 

Standing desks, description of, 
47, Fig. 20. 

Steam heating, discussion of, 
40, Fig. 17. 

Steinhaus, investigation by, 
regarding illness of school 
. children, 105. 

Sterilization of drinking water, 
8. 

Stockholm, average attend- 
ance per class in, 90. 

Storey, the work of, in New 
York, 147. 

Stoves, discussion of, 36-38. 

St. Petersburg, work of school 
physicians in, 167. 

Subjects, order of, in curricu- 
lum, 101, 102. 

Subnormal children, discus- 
sion of, 79, 80, 158, 159. 

Suggestibility, of girls in com- 

' parison with boys, 86. 

Suicides, of school children, 
135. 

Sundays, desirability of no 
work on, 139. 

Sunlight, influence of, 7, 
18. 

Sweden, investigation regard- 
ing the sleep of secondary 
school children in, 130. 

Swedish gymnastics, general 
use of, 118. 

Sweeping, not to be done 
shortly before school, 33. 

Swimming pools, for school 
children, 65. 

Switzerland, corporal punish- 
ment in, 134. 

Syncope, produced by heat, 
31. 



INDEX 



187 



Talk pauses, inaugurated by 
Mohaupt, 96. 

Teacher: additional work for, 
caused by medical inspec- 
tion, 161; hygiene of the, 
173; necessity of a knowl- 
edge of school hygiene for 
the, 145, 147; overwork of 
the, 174. 

Teljatnik, fatigue produced 
by physical exercise studied 
by, 120. 

Temperature, standard, for 
school room, 31. 

Thorax, deyclopment of, ham- 
jjered by bad desks, 47. 

Tiling: for classroom, 44; for 
toilets, 70. 

Tjaden, investigation by, re- 
garding anemia among sec- 
ondary school children, S4. 

Thlchftr, marking for cleanli- 
ness practised by, 94. 

Tobacco, discussion of, 151. 

Toilets: discussion of, 67-72, 
Fig. 33; for gymnasium, 61. 

Tonics, prescril)ed by sch()t)l 
physician, 167. 

Top of desk in relation to 
pupil, 51. 

Towel, the hygiene of the, 14. 

Training .schools, instruction 
in hygiene in, 146. 

Transom, location of, 24. 

Transportation of school chil- 
dren, 3. 

Travel, of children to and from 
school, 3, 91, 92. 

Tuberculosis, spread by dust, 
61. 

Turnen, use of, in gymnasium, 
118. 

Two-seated desk, prescribed 
in Sweden, 56. 

Type, discussion of, 108. 

United States: adjustable 
desks used in the, 49 co-edu- 



cation in the, 88; corpora 
punishment in the, 134; 
electric ventilation systems 
in the, 34; gymnastic appa- 
ratus in the, 57; law in, re- 
garding instruction in hy- 
giene, 152; medical inspec- 
tion of schools in, 171; 
secondary schools in the, 
129; school fire escapes in 
the, 74; school nurses in, 
166. 
Urinals, discussion of, 71, 72. 

Vacation Colonies, discus- 
sion of, 140, 141. 

Vacations, discussion of, 136- 
139. 

Ventilation: cond)ined with 
steam heating, 40; discus- 
sion of, 34-36 ; of cloak room , 
13; of dormitori^, 143; of 
schoolroom, 29; promoted 
by good .stoves, 36. 

Vermin, bred in moist floors, 
45. 

Vertical writing, discussion of, 
111-116. 

Vienna: morbidity of children 
in, 138; vacation camps of, 
140. 

Villamont school, desks used 
in the, 56. 

Viroflay, France, school and 
grounds at, 17. 

Vision, tests for, 161. 

Voice: culture and singing, 
122; of teacher in relation 
to size of room, 44. 

Volatile substances in expired 
air, 29. 

Waetzold, time spent on 
music found by, 127. 

Waiting rooms, necessity of, 
12. 

Wales, medical inspection in, 
170. 



188 



INDEX 



Walls of the classroom, 44. 

Walter, benches designed by, 
57. 

Wander schulen, in Scandina- 
via, 3. 

Wardrobes : between windows, 
24; hallways used for, 13; 
used for recreation space, 14. 

Warm days, suspension of 
school on, 139. 

Water supply: for shower 
baths, 64; impure, source of 
disease, 8, 68. 

Weichardt: estimation of fa- 
tigue by, 77; experiments 
with kenotoxin by, 75. 

Weight, gain in, during vaca- 
tions, 136. 

Weiss, statement by, concern- 
ing nearsightedness, 157. 

Wells, discussion of, 8, 9. 

Wiesbaden, plan of medical 
inspection in, 158, 168. 



Window frames, advantage of 

narrow,. 16, 24. 
Windows, discussion of, 24, 

25. 
Wingen, photometer by, 19. 
Women doctors, for girls' 

schools, 165. 
Writing, discussion of, 109- 

116. 
Wlirttemberg, suspension of 

school on warm days in, 

139. 

Xylolith, as a floor covering, 
45. 

Yard, school, for play, 62. 

Zirngast, study by, on ab- 
sence records, 138. 

Zollinger, desk series on cas- 
ters designed by, 56. 

Zurich, writing lessons in, 111. 



